M hiu: N_04_03_06/F07

Ngy hiu lc:

/ /2011

Ln ban hnh/ sa i: /

GIY NGH NG TI KHON

Request for Closing Account
Ngy (date) ..thng (month)..nm 20.
Khch hng: CNG TY C PHN THNG MI QUC T V CONG NGH U VIT
(Customers name)

a ch giao dich:68/12, T 3, VN QUN, H NG, H NI

(Contact Address)

CMND, H chiu:.........................................do CA....................................cp ngy:...../........../...............

(ID Card/Passport No).........................................................(issued by)............................................ (date)

in thoi: Nh ring:..................................c quan:.................................di ng: 0989584123

(Tel)

(Home)

(Office)

(Mobile)

ngh ng v ghi n Ti khon: 01100000122459

(Please closing and debit account)

S d hin ti (Current Balance): 3.000.000 VND

S TK (Acc No): 01100000122459

Bng s (In figure) : 3.000.000

Bng ch (In words): BA TRIU

Tn TK (Acc Name): CTY CPTMQT V CN U VIT

NG CHN

..

a ch (Address): 68/12, T 3, VN QUN, H NG, H NI

Ngn hng (With bank) SEABANK LNG H

YU CU NHN TIN (Money will be received):

Chuyn vo TK: 145146139
By transfer to Acc No

Tn TK: NG ANH TUN

Account Name

Ti NH:ACB CHI NHNH CHA H

With Bank

S tin:BA TRIU NG

Tin mt:.........................................................................................................................
In cash

Ngi nhn:...................................................................................................................
Reciever

CMND s:........................Ngy cp:..................... Ni cp:.................................

ID Card/Passport No
K TON TRNG

Chief Accountant

Date of issue

Place of issue

CH TI KHON (K v ng du)

Acc Holder sign & stamp

NGI NHN TIN K

Receiver sign

Amount

Ni dung: CHUYN TIN VO TI KHON

Details of payment

PHN DNH CHO NGN HNG (For bank use only)

S bt ton: ............................................
Ti khon ghi N: .................................
Ti khon ghi C: ..................................
CHUYN VIN QHKH TRNG PHNG

GIAO DCH VIN

KIM SOT

TH QU