Dear Bank of Taiwan, Tunhua Branch,
致臺灣銀行敦化分行:
I hereby request you to effect the following remittances subject to the conditions overleaf, which I have read and agreed to be bound by.
本人已閱讀并同意遵守此頁背面所列條款,茲委托貴行據(jù)此辦理下列匯款。
T/T M/T D/D
電匯 信匯 票匯
Date
日期
Amount
金額
Name of Beneficiary
收款人姓名
Address of Beneficiary
收款人地址
Name of Remitter
匯款人姓名
Address of Remitter
匯款人地址
Remarks
備注
Signature
簽名
In payment of the above remittance, please debit my account with you.
上述匯款支付辦法,從本人在貴行開立的賬戶中扣除。