diff --git a/src/routes/safe/components/Balances/SendModal/screens/SendCustomTx/index.jsx b/src/routes/safe/components/Balances/SendModal/screens/SendCustomTx/index.jsx
new file mode 100644
index 00000000..39b9a025
--- /dev/null
+++ b/src/routes/safe/components/Balances/SendModal/screens/SendCustomTx/index.jsx
@@ -0,0 +1,124 @@
+// @flow
+import React from 'react'
+import { withStyles } from '@material-ui/core/styles'
+import Close from '@material-ui/icons/Close'
+import IconButton from '@material-ui/core/IconButton'
+import Paragraph from '~/components/layout/Paragraph'
+import Row from '~/components/layout/Row'
+import GnoForm from '~/components/forms/GnoForm'
+import Col from '~/components/layout/Col'
+import Button from '~/components/layout/Button'
+import Block from '~/components/layout/Block'
+import Hairline from '~/components/layout/Hairline'
+import Field from '~/components/forms/Field'
+import TextField from '~/components/forms/TextField'
+import TextareaField from '~/components/forms/TextareaField'
+import {
+  composeValidators,
+  required,
+  mustBeEthereumAddress,
+} from '~/components/forms/validator'
+import SafeInfo from '~/routes/safe/components/Balances/SendModal/SafeInfo'
+import ArrowDown from '../assets/arrow-down.svg'
+import { styles } from './style'
+
+type Props = {
+  onClose: () => void,
+  classes: Object,
+  safeAddress: string,
+  etherScanLink: string,
+  safeName: string,
+  ethBalance: string,
+  onSubmit: Function,
+  initialValues: Object,
+}
+
+const SendCustomTx = ({
+  classes,
+  onClose,
+  safeAddress,
+  etherScanLink,
+  safeName,
+  ethBalance,
+  onSubmit,
+  initialValues,
+}: Props) => {
+  const handleSubmit = (values) => {
+    onSubmit(values)
+  }
+
+  const formMutators = {}
+
+  return (
+    <React.Fragment>
+      <Row align="center" grow className={classes.heading}>
+        <Paragraph weight="bolder" className={classes.manage} noMargin>
+          Send custom transactions
+        </Paragraph>
+        <Paragraph className={classes.annotation}>1 of 2</Paragraph>
+        <IconButton onClick={onClose} disableRipple>
+          <Close className={classes.closeIcon} />
+        </IconButton>
+      </Row>
+      <Hairline />
+      <Block className={classes.formContainer}>
+        <SafeInfo safeAddress={safeAddress} etherScanLink={etherScanLink} safeName={safeName} ethBalance={ethBalance} />
+        <Row margin="md">
+          <Col xs={1}>
+            <img src={ArrowDown} alt="Arrow Down" style={{ marginLeft: '8px' }} />
+          </Col>
+          <Col xs={11} center="xs" layout="column">
+            <Hairline />
+          </Col>
+        </Row>
+        <GnoForm onSubmit={handleSubmit} formMutators={formMutators} initialValues={initialValues}>
+          {() => (
+            <React.Fragment>
+              <Row margin="md">
+                <Col xs={12}>
+                  <Field
+                    name="recipientAddress"
+                    component={TextField}
+                    type="text"
+                    validate={composeValidators(required, mustBeEthereumAddress)}
+                    placeholder="Recipient*"
+                    text="Recipient*"
+                    className={classes.addressInput}
+                  />
+                </Col>
+              </Row>
+              <Row margin="sm">
+                <Col>
+                  <TextareaField
+                    name="data"
+                    type="text"
+                    placeholder="Data interface (ABI / JSON)*"
+                    text="Data interface (ABI / JSON)*"
+                  />
+                </Col>
+              </Row>
+              <Hairline />
+              <Row align="center" className={classes.buttonRow}>
+                <Button minWidth={140} minHeight={42} onClick={onClose}>
+                    Cancel
+                </Button>
+                <Button
+                  type="submit"
+                  variant="contained"
+                  minHeight={42}
+                  minWidth={140}
+                  color="primary"
+                  data-testid="review-tx-btn"
+                >
+                    Review
+                </Button>
+              </Row>
+            </React.Fragment>
+          )}
+        </GnoForm>
+      </Block>
+    </React.Fragment>
+  )
+}
+
+export default withStyles(styles)(SendCustomTx)