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To 致： The Hongkong and Shanghai Banking Corporation Limited

day 日 / month 月 / year 年
Date 日期
23-May-2019

OUTWARD TELEGRAPHIC TRANSFER / INTERBANK FUNDS TRANSFER

AMENDMENT / CANCELLATION / ENQUIRY REQUEST FORM
更改／取消／查詢匯出電匯／跨行轉賬申請表格

Important Notes 重要事項：

1. On top of the Bank's charges, the correspondent and/or beneficiary bank(s) may also charge you for handling this request.
除本行的費用外， 代理銀行及／ 或受款銀 行在處理閣下的申 請時，可能會 向您收取 有關服務費。

2. The Bank will inform you about the amendment or cancellation result as soon as reasonably practicable if the payment amount has not yet been debited from the
account. The Bank cannot guarantee that any cancellation instruction or amendment instruction that has been accepted by the Bank can be successfully executed
notwithstanding receipt by the Bank of this Request Form (whether or not your account has already been debited). 若付款款項尚未從戶口扣賬，本行會在合理可行的時
段內盡快通知閣下更改或止付指示的結果。儘管本行收到此申請表格並接受有關更改或止付指示，本行不能保證有關更改或止付指示可成功執行，無論有關款項是否已從閣下戶口中扣除。

3. Please note that acceptance of this amendment instruction is at the Bank's sole discretion. In the event that this amendment instruction cannot be processed or is
rejected by the Bank, please indicate in the form below whether you want the Bank to (i) cancel your original payment instruction and recall the funds; or (ii)
disregard your amendment instruction and continue to process your original payment instruction. 請注意：本行有權 決定是否接受此更 改指示。如本 行未能執 行或拒絕此
更改指示，請於下 面的表格中註 明閣下是 否希望本行： ( i) 取消閣下原本 的付款指示 並要求退款；或 (ii) 毋須處理閣 下的更改 指示並繼續處理原 本的付款指示 。

4. The Bank will communicate your amendment/cancellation/payment enquiry instruction below that has been accepted by us to the correspondent or beneficiary
bank. However, whether they will act on the instructions is at their absolute discretion and out of the Bank's control.
本行將會通知代理 銀行或受款銀 行下列被 本行接受的更改/取 消/查詢指示 ，但須視乎 代理銀行或受款銀 行會否就該指 示採取行 動，本行就此並無 控制權。

5. If the currency of the returned funds is not supported by the payment debit account, the funds will be converted into the payment debit account currency at the
Bank's prevailing exchange rate at the time of conversion. 如付款戶口並不支援有關退款的貨幣 ，該筆退款將 按本行當 時的匯率被折算為 付款戶口貨幣 。
6. For Integrated / Business Integrated Account, please specify Account Type (e.g. Savings / Current). For Foreign Currency Account, please specify currency to be
debited. 如屬綜合理財／商業綜合戶口，請註明戶口類別（如儲蓄／往來） 。如屬外幣戶口，請註明支賬的貨幣類別。
7. Your email address and contact number maintained in the Bank's record will be used for correspondence in respect of this instruction. Please ensure that your email
address and contact number with the Bank are up to date. 請確保您於本行維 持最新的電郵地址和電話號碼紀錄，本行 將以這紀錄用作此指示的聯繫通訊。

Details of Outward Telegraphic Transfer / Interbank Funds Transfer 匯出電匯／跨行轉賬資料 (Mandatory fields 必須填寫)
Payment Reference 付款參考編號 Payment Instruction Date / Payment Amount Debit Date (if applicable)
付款指示日期／付款扣賬日期 （如適用）

Beneficiary Name 受款人名稱 Payment Currency 付款貨幣 Payment Amount 付款金額

Instructions 指示 (Please tick where applicable 請在適當的地方加上剔號 )

1. Cancel the above Telegraphic Transfer / Interbank Funds Transfer 取消上述電匯／跨行轉賬

Account Number 戶口號碼

Please deposit the returned funds into my / our account5, account details are
請將該筆退款存入本人（等）的戶口 5，戶口資料為 Account Type 戶口類别 6 Currency 貨幣 6

2. Enquire the above Telegraphic Transfer / Interbank Funds Transfer 查詢上述電匯／跨行轉賬

Tick
Enquiry Details 查詢詳情
()
Beneficiary advised that the funds have not yet been received. Please check the status of the transaction
受款人仍未收到有 關款項，請查 詢交易狀 況

The funds received by the beneficiary were less than the payment amount. Please check the details regarding the difference
受款人收到的款項 少於付款金額 ，請查詢 差額詳情

The currency of funds received by the beneficiary was different from the instructed payment currency. Please check the transaction details
受款人收到的款項 貨幣與指示的 付款貨幣 不相符，請查詢交 易詳情

Others (please specify)

其他 （請註明）

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Instructions (Continued) 指示 （續） (Please tick where applicable 請在適當的地方加上剔號 )

3. Amend the above Telegraphic Transfer / Interbank Funds Transfer as follows:

更改上述電匯／跨行轉賬如下：
Note 注意： If you need to amend the payment currency, payment amount, beneficiary bank, beneficiary name and / or beneficiary account number / IBAN
of the above Telegraphic Transfer / Interbank Funds transfer the payment amount of which has not been released by the Bank, please cancel
the above Transfer and submit a new one. 如上述電匯／跨行轉賬的款項尚未匯出，而您需要更改付款貨幣、付款金額、受款銀行、受款人名稱及／或受
款人戶口號碼／IBAN，請取消上述轉賬並重新發出新的轉賬指示。

I/We understand that the acceptance of this amendment instruction is subject to the Bank's sole discretion. If this amendment instruction is rejected by the
Bank, please 本人（等）明白貴行有權決定是否接受此更改指示。如貴行拒絕此更改指示，請貴行

cancel the above Transfer and recall the funds 取消上述轉賬並要求退款

disregard this amendment instruction and continue to process the above Transfer 毋須處理此更改指示並繼續處理上述轉賬

Tick () Amendment Details 更改詳情

Beneficiary Name
受款人名稱

Beneficiary Account Number / IBAN

受款人戶口號碼／I BAN

Message to Beneficiary
給受款人附言

Intermediary Bank Details (e.g. SWIFT BIC or

Address) 中轉銀行資料（ 例如：SWIFT BIC 或地址）

Purpose of Payment
匯款目的

Others (please specify)

其他 （請註明）

(Mandatory fields for amendment instructions 更改指示必須填寫 )

If the above Telegraphic Transfer / Interbank Funds Transfer is returned to the Bank before this amendment instruction that has been
accepted by the Bank is effected, please 如上述電匯／跨行轉賬在此被貴行接受的更改指示生效前已被退回，請貴行

Account Number 戶口號碼

deposit the returned funds into my / our account5, account details are
將該筆退款存入本人（等）的戶口 5，戶口資料為 Account Type 戶口類别 6 Currency 貨幣 6

resend the Telegraphic Transfer / Interbank Funds Transfer according to amended information, with the amount of
根據以上的更改指示重新匯出該筆電匯／跨行轉賬，金額為

Tick () Amount 金額

net returned amount 淨退回金額

Account Type 戶口類别 6 Currency 貨幣 6

original amount, and deduct the difference in amount (if any) from the original
Debit Account 原本指示的金額，並在原 本的付款戶口扣除 差額 （如有）

OUTWARD TELEGRAPHIC TRANSFER / INTERBANK FUNDS TRANSFER AMENDMENT / CANCELLATION /

ENQUIRY REQUEST FORM 更改／取消／查詢匯出電匯／跨行轉賬申請表格 Page 頁次 2/3
REM145R10-m (220519) V F W
Charges 費用

Account Number 戶口號碼 (Mandatory fields 必須填寫)

Local charges and overseas charges1 are to be paid from my /
our account, account details are as follows: Account Type 戶口類别 6 Currency 貨幣 6
本地費用及海外費用 1 從本人（等）的戶口支付，戶口資料為：

Please sign if the Account Number for charges is different from the Debit Account Number below
如支付費用的戶口號碼與下列的付款戶口號碼不相同，請簽署

S.V.

Signature and Details of Customer 客戶簽署及資料 (Mandatory fields 必須填寫)

Signature(s) 簽署 Full Name(s) (in Block Letters) 全名（請用正楷填寫）

S.V.
Debit Account Number of the above Outward Telegraphic Transfer /
Interbank Funds Transfer 上述匯出電匯／跨行轉賬的付款戶口號碼

For Bank Use Only 銀行專用

Branch Chop Authorised Signature (for S.V.) with Signature Number or Staff Number

OUTWARD TELEGRAPHIC TRANSFER / INTERBANK FUNDS TRANSFER AMENDMENT / CANCELLATION /

ENQUIRY REQUEST FORM 更改／取消／查詢匯出電匯／跨行轉賬申請表格 Page 頁次 3/3
REM145R10-m (220519) V F W