离岸业务汇款申请书
APPLICATION FOR FUND TRANSFERS
致：平安银行
TO：PING AN BANK
日期：
DATE
*收款人 BENEFICIARY’S NAME：
*收款人地址 BENEFICIARY’S ADDRESS：
*收款人帐号 BENEFICIARY’S ACCOUNT NO.：
*收款银行名称及地址 BENEFICIARY’S BANK NAME & ADDRESS：
*收款行 SWIFT CODE.：
收款行之代理行名称及地址   CORRESPONDENT OF BENE’S BANK NAME & ADDRESS：
代理行 SWIFT CODE：
银行专用
FOR BANK USE ONLY
手续费
COMMISSION
电报费
CABLE CHARGES
合计
TOTAL CHARGES
核印
SIG. VER.
*汇款币种及金额 CURRENCY & INTERBANK SETTLEMENT AMOUNT：
小写  IN FIGURES：
大写 IN WORDS：
*汇款人名称 REMITTER’S NAME：
*汇款人地址 REMITTER’S ADDRESS：
*附言 REMITTANCE INFORMATION：
*国内外费用承担方 ALL BANK’S CHARGES IF ANY ARE TO BE BONE BY：
有关上述款项及一切费用，请支敝帐户： AS TO PAYMENT OF THE ABOVE TRANSFER AND YOUR BANK CHARGES， YOU ARE AUTHORIZED TO DEBIT MY/ OUR ACCOUNT WITH YOUR BANK.
*帐号 A/C NO.
申请人签署
APPLICANT’S SIGNATURE
（请用留存我行之印鉴签署PLEASE USE THE SIGNATURE（S）FILED WITH THE BANK）
*联系人 CONTACT PERSON：
*联系电话 TEL NO：
经办MAKER：
复核CHECKER：
主管AUTHORIZED PERSON：
填写前请仔细阅读各联背面条款及填写说明
Please read the condition and instructions overleaf before filling in this application.
第一联
银行会计凭证
条 款
一） 申请人应仔细审阅本申请的各项条款内容。将详细的付款信息填写到相关栏目内。如因填写错误或字迹不清而引起款项迟付、错付，平安银行（以下简称“本行”）概不负责。
二） 倘因下列情形而引致的任何损失，包括：款项交付或通知延误；书函、电报或其它文件在寄发或传送途中发生的错误、残缺、遗漏、中断或延误；代理行或同业的行为；战争、检查、封锁、政变或骚乱；本地或外国政府或其行政机构所施行的一切法律、法令、条例、管制或其它难以控制的事故，本行概不负责。
三） 对于委托解付汇款的代理行或同业银行的一切错误、疏忽或过失，本行概不负责。
四） 对此汇款要求修改汇款内容或退汇，申请人须亲自携带有效证明或文件到本行办理。待本行接到有关同业银行证实汇款已取消后方能办理退汇手续。所有因为此笔汇款而引起的费用，概由申请人承担。
五） 请保存好客户回单以备日后查询。
六） 如您对本协议存在任何意见或建议，您可通过客服电话（投诉热线95511-3-8、95511-2-8（信用卡））、官方网站（http://bank.pingan.com）“在线客服”、平安口袋银行APP“在线客服”、平安数字口袋APP“在线客服”、投诉电子邮箱callcenter@pingan.com.cn，或平安银行各营业网点进行咨询和反馈。我行受理您的问题后，将在时效内核实并为您提供解决方案。
CONDITIONS
1) All payment instructions should be checked carefully by the applicant in each case and fill in all the details of payment information in each proper blank space, PING AN BANK(Hereafter called the Bank)shall not be liable for any delayed payment or incorrect payment Caused by the wrong information given or unclear writing.
2) The Bank shall not be liable for any loss or damage due to delay in payment or in giving advice of payment, loss of items is transit or otherwise, mutilation, error, omission, interruption or delay in transmission or delivery of any item, letter, telegram or cable or the actions of our correspondents, sub-agents or other agencies or declared or undeclared war, censorship, blockade, insurrection, civil commotion, or any law, decree, regulation, control, restriction or other act of a domestic or of foreign government or other group or group exercising governmental powers, whether de jure or de facto, or any act or event beyond our control.
3) The Bank shall not be liable for errors, neglects, or defaults of any correspondents, sub-agents, or other agencies.
4) Any request for amendment or cancellation has to be made by the applicant in person upon production of proper identity document, and refund can only be made by the Bank, upon receipt of its correspondents effective confirmation of the cancellation and the Bank is entitled to reimbursement form the applicant for the expenses of the Bank, its correspondents and agents.
5) Please retain the customer’s receipt for future enquires.
6) Any questions or related complaints or opinions, please contact cu​​stomer service 95511-3-8, credit card service 95511-2-8, official website: http://bank.pingan.com, pocket bank APP (online customer service), digital pocket APP(online customer service), send email to callcenter@pingan.com.cn, or consult or reflect through the branches of PING AN BANK. After accepting your problems, The Bank will check the actual items and contact you to provide solutions within the specified time.