申请日期 Application Date
汇 款 申 请 书
APPLICATION FOR OUTWARD REMITTANCE OR
*汇往境外，汇款申请书请以英文填写（For cross-border payment by T/T, please complete this form in English.）.
汇款方式
Means Of Payment
如未在□内“√”选，则默认为电汇（if not specified，the method of payment defaults to T/T）
□电汇（T/ T/）□信汇（M/T） □票汇，付款地点 D/ D, drawn on ,取票人姓名 person designated to collect,
身份证件名称 type of ID ,身份证件号码 ID number
汇款人
Remitter
账号（A/C No.） OSAOSAOSAOSA
户名（Name）
币种及金额（小写）Currency&Amount in figures 币种及金额（大写）Currency&Amount in Words
收款行之代理行
Correspondent of
Beneficiary’s Bank
SWIFT代码(SWIFTCode )
名称(Name)
地址（含国家、省（州）、市）(Address)
收款行
Beneficiary’s Bank
SWIFT代码(SWIFTCode )
英文名称(Name)
地址（含国家、省（州）、市）(Address)
收款人
Beneficiary
收款人类型
□公司 □个人
账号(A/C No.)
户名（Name）
地址（含国家、省（州）、市）(Address)
汇款附言 (限 105 个字符) Remittance Information (not to exceed 105
letters)
银行费用承担方式 All Bank Charges Are To Be Borne By：
□ 汇款人 Remitter □全额到账（仅供美元）
Without any deduction ( for USD only)
□收款人 Beneficiary
□共同承担（默认）Share (Default)
如未在□内“√”选，则默认为“共同承担”
本人（等）已详阅、了解和同意贵行离岸汇款相关规则以及背面条款，特委托贵行依此指令
办理离岸款项汇出事宜。 I/We hereby declare that I/We have understood and accepted your rules and the conditions
on the back page completely and you are requested to effect the payment as per the above instruction.
汇款人印鉴 Remitter’s Signature(s):
支付密码 Test Key
联系人姓名及电话 Contact
Person & Tel. No.
备注 Special Instructions
银行专用栏(For(For(For(ForBankBankBankBank UseUseUseUseOnly)Only)Only)Only)
核印
核印相符，核印编号： 核印人名章：
电话确认
月 日 时 分与 电话确认
被确认人电话 ：
确认人名章：
扫描
扫描编号： 扫描人员名章：
重传说明及备注
票汇专用
分行汇票收取人姓名： 邮编： 联系电话：
收件地址：
附 1
条 款
一、如因下列情形而引致之任何损失，包括但不限于款项交付或通知延误；书函、电报或其他文件在寄发或传
送途中遗失、残缺、错误、遗漏或延误；代理行或同业之行为；战争；检查或骚乱等；本地或外国政府或
其行政机构所施行之一切法律、法令、条例、管制及其他难以控制之事故，本行概不负责。
二、有关电汇汇款之一切电文，本行可用文字或密码发出；对于代理行或同业之一切错误、疏忽或过失，或于
收到时误解；本行概不负责。
三、在中国以外引致之一切费用收款人未支付，本行有权要求汇款人负担所有因此汇款而导致之一切费用。
四、此汇款如需退汇或更改，汇款人须候本行接到同业通知证明汇款已取消及按同业实际退回之款项照本行当
日适用的汇率折算退回汇款人。本行有权要求汇款人负担所有因此而引致之一切费用。所有已收的电报费、
邮费及手续费恕不退还。
五、此汇款如为换汇后按换汇币种汇出的，遇同业退回时本行将按入账当日的本行适用的汇率折算为原换汇币
种并退回汇款人。
CONDITIONSCONDITIONSCONDITIONSCONDITIONS
1. The Bank shall not be liable for but not limit to any loss or damage due to delay in payment or in
giving advice of payment; loss of items in transit or otherwise, mutilation, error, omission or delay
in transmission or delivery of any item, letter, telegram or cable or the actions of our correspondents
or other agencies or declared or undeclared war; censorship; civil commotion etc; or any law, decree,
regulation, control, restriction or other act of a domestic or of foreign government. or other group or
groups exercising governmental powers, whether de jure or de facto, or any act or event beyond our
control.
Bank may send any message relative to telegraphic transfer either literally or in cipher and is
not to be liable for errors, neglects, or defaults of any correspondents, or other agencies; or from its
misinterpretation when received.
3. All charges incurred outside China are for the account of the beneficiary. However, the Bank is
entitled to reimbursement from the applicant/remitter for the expenses of the Bank, its
correspondents and agents.
4. Any request for cancellation or amendment has to be made by the applicant/remitter in person upon
production of proper identity documents, and refund can only be made by the Bank upon receipt of
its correspondent’s effective confirmation of cancellation and at the Bank’s exchange rate for the
currency of the remittance at the time of refund. The Bank is entitled to reimbursement from the
applicant/remitter of the expenses so incurred by itself and its correspondents or agents. All
cable/postage charges and commission collected are not refundable.
5. If the currency A had been converted into currency B for remittance, in case of return by the Bank’s
correspondent, the Bank would refund the applicant/remitter in the original currency A after
converting currency B back to currency A at the exchange rate of the date of refunding.
