花旗境外汇款申请书

境外汇款申请书 APPLICATION FOR FUNDS TRANSFERS (OVERSEAS)

致:花旗银行(中国)有限公司 TO:___BJ_____________分行

日期 Date

X 电汇 T/T □ 票汇 D/D □ 信汇 M/T 申报号码 BOP Reporting No. 20 银行业务编号 Bank Transac. Ref. No. 32A 汇款币种及金额 Currency & Interbank Settlement Amount 现汇金额 Amount in FX 其中购汇金额 Amount of Purchase 其他金额 Amount of Others 50a 汇款人名称及地址 Remitter's Name & Address

发电等级 Priority □ 普通 Normal □ 加急

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收电行/付款行 Receiver / Drawn on 金额大写 Amount in Words 账号 Account No./Credit Card No. 账号 Account No./Credit Card No. 账号 Account No./Credit Card No.

□对公组织机构代码Unit Code□□□□□□□□-□ 54/56a 收款银行之代理行名称及地址 Correspondent of Beneficiary's Bank Name & Address 收款人开户银行名称及地址 Beneficiary's Bank Name & Address 收款人名称及地址 Beneficiary's Name & Address

□ 对私

个人身份证件号码 Individual ID NO. □中国居民个人Resident Individual □中国非居民个人Non-Resident Individual

57a

收款人开户银行在其代理行账号 Bene's Bank A/C No.

59a

收款人账号 Bene's A/C No.

汇款附言 Remittance Information

只限140个字位 Not Exceeding 140 Characters

71A 国内外费用承担 All Bank's Charges If Any Are To Be Borne By X 汇款人OUR □收款人BEN □共同

收款人常驻国家(地区)名称及代码 Resident Country/Region Name & Code 请选择：□ 预付货款 Advance Payment □ 货到付款 Payment Against Delivery □ 退款 Refund 交易编码 BOP Transac. Code 相应币种及金额

□□□ □ 其他 Others 交易附言 Transac.Remark 最迟装运日期

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Currency & Amount □ 否

是否为进口核销项下付款 □ 是外汇局批件/备案表号报关单号报关单号银行专用栏 For Bank Use Only 购汇汇率 @ Rate 等值人民币 RMB Equivalent 手续费 Commission 电报费 Cable Charges 合计 Total Charges 支付费用方式 □ 现金 by Cash In Payment of □ 支票 by Check the Remittance □ 账户 from Account 核印 Sig. Ver.

合同号报关单经营单位代码

发票号

□□□□□□□□□□ 本次核注金额本次核注金额银行签章 Bank's Signature

报关单币种及总金额报关单币种及总金额申请人签章 Applicant's Signature 请按照贵行背页所列条款代办以上汇款并进行申报 Please Effect The Upwards Remittance, Subject To The Conditions Overleaf:

申请人姓名核准人签字 Name of Applicant Authorized Person 电话日期 Phone No. Date 经办 Maker 复核 Checker 填写前请仔细阅读各联背面条款及填报说明 Please read the conditions and instructions overleaf before filling in this application

境外汇款申请书

APPLICATION FOR FUNDS TRANSFERS (OVERSEAS)

致:花旗银行（中国）有限公司日期 Date

花旗境外汇款申请书