境内汇款申请书

APPLICATION FOR FUNDS TRANSFERS (DOMESTIC)致TO:□ 电汇 T/T □ 票汇 D/D □ 信汇 M/T进口核销专用申报号码 Report No.20银行业务编号 Bank Transac.Ref. No.32A汇款币种及金额Currency & Interbank Settlement Amoun现汇金额 Amount in FX其购汇金额 Amount of Purchase中其他金额 Amount of Others50a汇款人名称及地址Remitter's Name & Address日 期 Date

发电等级□ 普通 Normal □ 加急 UrgentPriority □□□□□□ □□□□ □□ □□□□□□ □□□□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.□ 对私□对公 组织机构代码Unit Code□□□□□□□□-□54/56a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收款银行之代理行名称及地址Correspondent ofBeneficiary's Bank Name& Address57a收款人开户银行名称及地址收款人开户银行在其代理行账号 Bene's Bank A/C No.Beneficiary's Bank Name& Address第二联外汇局59a收款人名称及地址收款人账号 Bene's A/C No.Beneficiary's Name & Address70汇款附言Remittance Information只限140个字位 Not Exceeding 140 Characters71A留国内外费用承担All Bank's Charges If Any Are To Be Borne By存□汇款人OUR □收款人BEN □共同SHA联收款人常驻国家（地区）名称及代码 Resident Country/Region Name & Code□□□本笔付款是否为进口核销项下付款是 □ 否 □最迟装运日期本笔付款请选择： □ 预付款 Advance Payment □ 货到付款 Payment Against Delivery □ 退款 Refund □ 其他 Others保税区□ 出口加工区□ 钻石交易所□ 离岸账户□ 深加工结转□ 其他□付汇性质□□□□□□相应币种及金额BOP Transac. Code□□□□□□Currency & Amount交易编码进口付汇备案表号 / 批件号报关单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 CashIn Payment of□ 支票 by Checkthe Remittance□ 账户 from Account核印 Sig. Ver.申请人姓名Name of Applicant报关单经营单位代码报关单币种及总金额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进口核销申报Please Effect The Upwards Remittance, SubjectTo The Conditions Overleaf:合同号发票号□□□□□□□□□□本次核注币种金额本次核注币种金额本次核注币种金额银 行 签 章Bank's Signature核准人签字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