致：花旗银行（中国）有限公司日 期 Date
TO:___BJ_____________分行
发电等级
Priority □ 普通 Normal □ 加急 Urgent
申报号码 BOP Reporting No.2032A 50a 54/56a
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.
70只限140个字位 Not Exceeding 140 Characters 71A
收款人常驻国家（地区）名称及代码 Resident Country/Region Name & Code
最迟装运日期
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□ 是□ 否
合同号
外汇局批件/备案表号申请人姓名核准人签字Name of Applicant Authorized Person 电话日期Phone No.Date
支付费用方式□ 现金 by Cash In Payment of □ 支票 by Check the Remittance □ 账户 from Account Plea read the conditions and instructions overleaf before filling in this application
核印 Sig. Ver.
经办 Maker 复核 Checker
手续费Commission 电报费Cable Charges
合计Total Charges For Bank U Only
Applicant's Signature
Bank's Signature
购汇汇率 @
请按照贵行背页所列条款代办以上汇款并进行申报Rate 等值人民币Plea Effect The Upwards Remittance, Subject To The Conditions Overleaf:
RMB Equivalent
本次核注金额
银行专用栏申 请 人 签 章银 行 签 章报关单号
报关单币种及总金额
报关单经营单位代码
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报关单号报关单币种及总金额本次核注金额是否为进口核销项下付款发票号
BOP Transac. Code
Currency & Amount
Transac.Remark
汇款附言国内外费用承担
Remittance Information
All Bank's Charges If Any Are To Be Bor
X 汇款人OUR □收款人BEN □共同SHA
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请选择：□ 预付货款 Advance Payment □ 货到付款 Payment Against Delivery □ 退款 Refund □ 其他 Others
交易编码相应币种及金额
交易附言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
汇款人名称及地址
Remitter's Name & Address
□对公 组织机构代码Unit Code □□□□□□□□-□□ 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
收款银行之代理行名称及地址
汇款币种及金额
金额大写Currency & Interbank Settlement Amount
Amount in Words
其 中现汇金额 Amount in FX
账号 Account No./Credit Card No.其他金额 Amount of Others
账号 Account No./Credit Card No.
购汇金额 Amount of Purcha
账号 Account No./Credit Card No.境 外 汇 款 申 请 书
APPLICATION FOR FUNDS TRANSFERS (OVERSEAS)
X 电汇 T/T □ 票汇 D/D □ 信汇 M/T
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银行业务编号
收电行/付款行 Bank Transac. Ref. No.
Receiver / Drawn on
N
