致：北京证券有限公司.pdfVIP

致 : 北京證券有限公司 To : Beijing Securities Ltd. 提款指示表格FUND WITHDRAWAL INSTRUCTION FORM 請以正楷清楚填寫及簽署此表格，並傳真至(852) 2299 6099 或電郵至cs@ 或郵寄交回本公司。 Please complete and sign this form legibly in BLOCK LETTERS and return it to our Company by fax at (852)2299 6099 or by e-mail to cs@ or by mail to our office. 證券帳戶號碼Account Number ： 客戶名稱 Client Name ： 提取金額 Withdrawal Amount : _____________________________ 日期Date : ___________________ 本人現通知貴公司在戶口內提取以上金額並根據以下指示處理 :- I hereby notice to you arrange to withdrawal the above amount from our account as the following payment instruction :- 存入銀行之指示 Fund Deposit Instruction □(請於適當處畫上“”號) (Please“ ”tick where appropriate) □ 存至開戶所指定之存款銀行戶 Credit to my designated bank account under Account Agreement □ 以支票過戶 By Crossed Cheque □ 以銀行電子轉帳或電匯 (By Chats/TT) 至To : 銀行名稱Bank Name : _______________________________________________ 銀行地址Bank Address : _____________________________________________________________ _____ __________________________________________________________________ __________________________________________________________________ _______________________收款銀行代碼SWIFT Code : ________ ____________ 戶口名稱Account Name : _____________________________________(必須是開戶客戶的名稱) 戶口號碼 Account No. : _______________________________________ □ 親自前往貴公司提取支票(I will collect the cheque at your company’s office in person □ 其他(Others) : ____________________________________________________________________ 客戶謹此聲明以上所提供的資料均屬真實及正確。 The Client hereby declares that the information given above is true and correct. s.v. 客戶簽署Client Signature 客戶主任簽署AE Signature (請用存檔於本公司記錄