賬戶服務申請書2022-12-09.pdf
賬戶服務申請書2022-12-09.pdf
Attended By 列印 ＰＲＩＮＴ 銀行專用 Approved By For Bank Use 重置 ＲＥＳＥＴ 東莞銀行股份有限公司 (於中華人民共和國註冊成立的股份有限公司) Bank of Dongguan Co., Ltd. (A joint stock company incorporated in the People’s Republic of China with limited liability) Date 賬戶服務申請書 Account Service Application Form 日期 (日/月/年) DATE (DD/MM/YYYY) 致: 東莞銀行股份有限公司 - 香港分行 (「銀行」) To: Bank of Dongguan Co., Ltd. - Hong Kong Branch (the “Bank”) 注意 NOTE: 1.請用正楷填寫，在適當方格內加上“ ” ，填妥表格後交回本銀行。Please complete in BLOCK LETTERS, “ ” where appropriate, and return the completed form to the Bank. 2.所收費用將列印在閣下的戶口結單內。 Charge levied on your instruction(s) will be reflected on your account statement. 3.請預留 3-5 個工作天辦理 Please allow 3-5 working days for processing 甲部 Part A ─ 客戶資料 Customer Information 客戶號 Customer No. 客戶名稱 Customer Name 乙部 Part B ─ 所需文件 Document(s) Request (可多於一項 Please more than one item if applicable) 請發給本人(等)下列戶口文件 Please issue the following document(s) of my/our Account 證明函 Certificate Letter □ 餘額證明 # Certificate of Balance # 資信證明 截至日期 Date as □ 語言 Language 致 Attention to: □ 有關機構 Whom it may concern # 幣別 # Currency □ 所有幣別 All currency # 定期賬戶號碼 # Fixed Deposit Account No. □ 申請份數 No. of copy (s) □ Bank Reference Letter □ 港幣 HKD 其他: Other: □ □ 中文版 Chinese 英文版 English □ □ 中英文版 Chinese & English ________________________________________________________________________ 美元 USD □ 人民幣 CNY □ 其他: Other: ___________________________ (1) ____________________________________ (2) __________________________________ (3) ________________________________ (4) ____________________________________ (5) __________________________________ (6) _________________________________ 備註 Remark: 賬戶號碼 Account No. □ 由: (月/年) From: (MM/YYYY) 至: (月/年) To: (MM/YYYY) 幣別 Currency 金額 Amount 重發月結單副本 Reissue of Monthly Statement Copies 日期(日/月/年) DATE(DD/MM/YYYY) □ 重發定期存款/ 戶口交易回單 Reissue of Fixed Deposit / Transaction Advice □ 其他 Others 交易編號 Transaction Reference 地址:香港中環金融街8號國際金融中心二期25樓2504-2511室 Address: Suites 2504-2511, 25thFloor, Two International Finance Center, 8 Finance Street, Central, Hong Kong 頁次 Page 1/2 丙部 Part C ─ 收費 Charge □ 請將有關費用由本人(等)之戶口支取 Please debit all charges incurred from my/our account: 戶口號碼 Account No.: □ 附上支票,支票號碼 Enclose Cheque No.: _____________________________________ □ 其他: Other: __________________________________________________________________________ 丁部 Part D ─ 收取方式 Collection Method (只可 一項 Please one item only) □ 至銀行記錄中的通訊地址 Sent to the correspondence address in Bank record □ 郵寄 □ 快遞到付 □ 快遞寄付 By Mail By courier (Receiver) By courier (Shipper) □ 電郵至銀行記錄中的聯絡人郵箱 Sent by E-Mail to the contact email in Bank record □ 由下述指定授權人領取 Held for Collection by the following authorized person 姓名: Name: 證件號碼: ID No. : __________________________________________________ __________________________________________________ (中英文義如有歧異，請以英文本為準。The English version shall prevail if there is a discrepancy between the English & Chinese versions.) 客戶(等)簽署 Signature(s) of Customer(s) S.V. X__________________________________________________________ 請用留存本行印鑑/署名簽署 Please use signature(s)/chop(s) filed with the Bank 本人證實收到上述文件 I hereby acknowledge receipt of the above document 經辦 X__________________________________________________________ 收件人簽署 Signature of Recipient 日期 Date: _______________________________________ 地址:香港中環金融街8號國際金融中心二期25樓2504-2511室 Address: Suites 2504-2511, 25thFloor, Two International Finance Center, 8 Finance Street, Central, Hong Kong 頁次 Page 2/2