P.

ANK OF' CHINA Sit1gJ1p1r It

Remittance Apphc2ltion Form

0 t0:

*mcrndatory field for

Ref No

AAmanijaforv fi eld for RMB Fre-settle merit rem ttance &/ or ' occount holder I**l

>A1rA:REM1 R'S PARTICULARS

Full Name of Remitter *

identity card! Passpo No*

*C ta No

*Any account(s) maintained with Bank of China Limited, Singapore Branch Yes N
*Remftter'5 Address
(no PC Box address P0 BOX)

(please pwvide proof of address for non,account holder 1' 1)1ii ijElj)

*0estinati count of outward remittan

"i' Nationality

**Date of birth

'1" Occupation/Name of employer z

i
*Currenc Amu t

Exchange Rate

(For Bank use oril

*Beneficiary Name
(Name irs English Character mtstbe provided
Beneficiary 's Contact N
Beneficia s ID NumberA
*BenefIcia sAddress
*Benoficiaryls Account Number
eBeneficiary Bank Name/Address/SWI BIC
*Intermediary Bank's Name/SWI BIC&its country

CNAPS No

(Only msrsdatory for CNY reniittanceto China)

Message to Beneficiary: (not more than 15 words 15 :

-
*Agent Bank Charge (choose one only) If not indicated1 BEN
below apply

*Settlement Instruction for Application by Remitter (choose one only

Cash thers
(BEN) Borne Beneficiary
UR) Borne by Remitter

ebit account

Ins mt otion by FAX (Compulsory Ckif you re submi ngthis application by FAX Please
note that instruction by fax is Only SU act to prior arrangementwith and approval ythe Bank.)
By signing on this appLication form, We confirm that we have read, understood and acce0ted the declaration clause printed overleaf a0d authorize
Bank"China Limited,Singapore Branch (hereinafter referred to as the "Bank") to effect this transaction entirely at my! our own risk without
responsibi on the Bank's part and I/we agree to abide b the arms and Conditions for Remittance&Personal RM Pre-Settlement Remittance
Service (if applicable) printed overleaf. lit
/

SuppO Eng ecume

Yns/No

Remitter's signature&Company stamp (if applicable)

5ignture vorified
by

e d

Bank of China Limited, Singapore Branch Co. Rep. No. S3BFCO753G

LCD-2014-01B (Form 5a1) Nov.20