对账单/通知单补打申请表 - 汇丰银行

To: The Manager :
HSBC Bank (China) Company Limited.
___________________________Office
Date ____________________
Statement/Advice Reprinting Application Form
/
Note :
1. Please tick ( √ ) where applicable and complete this form in BLOCK LETTERS.
( )
2. Please cross out those not applicable.
3. Only for paper statement/advice reprinting.
Customer Name
Customer Number
_________________________________________ ________________________
Reprinting Reason
Not Received Received but lost Accounts Verification Others
____________
Type
Composite Statement
Total Copies [ ]
Statement Date _____________________________________________________________
Regular Statement
Total Copies [ ]
Account Number ___________________ Statement Date __________________
Account Number ___________________
Statement Date __________________
Account Number ___________________
Statement Date __________________
Account Number ___________________
Statement Date __________________
Advice
Total Copies [ ]
Account Number Transaction Date Amount
_____________________
________________ _________________
Account Number Transaction Date Amount
_____________________
________________
_________________
Account Number Transaction Date Amount
RESTRICTED

_____________________
________________
_________________
Delivery Method
Counter Collection
For personal customer, account holder should come in person to branch/sub-branch counter.
/
For entity customer, please provide name and ID number of authorized person for collection.
Authorized Person’s Name
Authorized Person’s ID Number
_______________________
_____________________________
Mail to Correspondence Address
Remarks
You are hereby authorized to debit any charges for this service from my/our account: ________________
/
/______________________
For detailed fee charges, please check and
in our website download centre.
Customer Signatory
_____________________________________________________________________
Customer Signatory(ies)/Chop(s)
*Personal customer should sign it by account holder.
*Entity customer should sign it by any group of authorized signatory(ies)/Chop(s).
RESTRICTED