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[]
[]
[]
["株式会社　肥後銀行　御中",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"外国送金依頼書兼告知書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取組番号",null,null,null,null,null,null,null,"　-TTR-　　"]
[]
["TO:The Higo Bank,Ltd",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"APPLICATION FOR REMITTANCE WITH DECLARATION"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"前回取組番号等"]
["太枠内にブロック体の英文字大文字でご記入ください（PLEASE FILL IN THE THICK-LINED FRAME IN BLOCK LETTERS.)"]
["該当事項に✓印を付してください。（PLEASE MARK WITH \"✔\" WHERE PERTINENT.)"]
["【ご注意】外国送金は外国の事情、慣習その他の事由から送金の取扱・銀行の責任等について国内送金と異なる点がありますので「外国送金取引規定」をご確認ください。"]
["【NOTE】PLEASE OBSERVE CAREFULLY TERMS AND CONDITIONS OF FOREIGN REMITTANCE TRANSACTIONS. ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"取扱店使用欄　（店名　　　　　　　　    　　　　　　　　　　　　　　）"]
["          AS THE HANDLING OF OVERSEAS REMITTANCES IS  SUBJECT TO CHANGE ACCORDING TO THE  RESPONSIBILITIES"]
["          OF EACH BANK CONCERNED DUE TO DIFFERENCES IN NATIONAL CUSTOMS, PRACTICES, LAW, ETC.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「仕向送金チェックシート」（PC　国際319）にて送金可否を確認のうえ送金取組しました。",null,null,null,null,null,null,null,"検 印",null,null,null,null,null,"担当者印"]
[]
[null,"送金依頼日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送金指定日（依頼日と異なる場合ご記入ください）"]
[null,20,null,null,null,null,"（YY）",null,"年",null,"（MM）",null,"月",null,"（DD）",null,"日",null,20,null,null,null,null,"（YY）",null,"年",null,"（MM）",null,"月",null,"（DD）",null,"日"]
[]
[]
[]
[null,"支払方法（PAYMENT INSTRUCTION)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"関係銀行手数料(CHARGES FOR THE BANKS CONCERNED,IF ANY,ARE FOR A/C OF)"]
[null,"口座振込\n(ADVICE AND CREDIT)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"☑",null,null,null,"受取人負担(BENEFICIARY)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□",null,null,null,"依頼人負担(APPRICANT)"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（注）海外の銀行によっては、本手数料とは別に受取人から独自の手数料を徴求する場合や、後日送金ご依頼人に手数料"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"を請求させていただく場合があります。また、全額が受取人に支払われることをお約束するものではありません。"]
[null,"送金通貨(CURRENCY)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送金金額(AMOUNT)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EX取引",null,null,null,null,null,"換算相場",null,null,null,null,"邦貨換算額"]
[null,"USD"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NON-EX取引",null,null,null,null,null,"相手科目",null,null,null,null,null,"外貨預金",null,null,null,null,null,"外貨通貨　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（円建除く）",null,null,null,null,null,null,null,null,null,null,null,"米ドルT/C"]
[null,"受取人氏名（BENEFICIARY'S NAME IN BLOCK LETTER)"]
[]
[]
[]
[null,"受取人住所（BENEFICIARY'S ADDRESS)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"州名・省名(STATE/PROVINCE)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国名(COUNTRY) "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お電話(PHONE NO.) "]
[null,"受 取 人\n取引銀行\n(ACCOUNT TO BE CREDITED WITH)",null,null,null,null,null,null,"銀行名(BANK'S NAME)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"銀行コード（SWIFT.ABA No等）"]
[]
[]
[null,null,null,null,null,null,null,null," 支店名または住所（BRANCH OR ADDRESS) 　※都市名（CITY)、州名(米国・カナダ・オーストラリアの場合）、省名（中国の場合）、国名を必ずご記入ください."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"州名・省名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(STATE/PROVINCE)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国名(COUNTRY）"]
[null,null,null,null,null,null,null,null," 経由銀行(THROUGH BANK)"]
[null,null,null,null,null,null,null,null," 受取人口座番号 (BENEFICIARY'S A/C NO. OR IBAN)　※IBAN採用国向けの場合、IBANを必ずご記入ください。"]
[]
[]
[null,"受取人宛\n連絡事項",null,null,null,null,null,null,"必要な場合のみご記入ください"]
[null,null,null,null,null,null,null,null,"(MESSAGE,IF ANY)　"]
[null,"送金目的",null,null,null,null,null,null,"□","輸入代金",null,null,null,null,"□","仲介貿易代金",null,null,null,null,null,null,null,null,null,"商品名"]
[null,"(PURPOSE)",null,null,null,null,null,null,"□","その他",null,null,null,"（",null,null,null,null,null,null,null,null,null,"）",null,"(MERCHANDISE)"]
[null,"原産地（国名）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"船積地（国名）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都市名"]
[]
[null,"仲介貿易の場合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（お客様申告欄）　　　　　",null,null,null,null,null,null,null,"□",null,"「外国為替及び外国貿易法」のイラン･北朝鮮関連規制およびロシア･ベラルーシ関連規制に\n該当しません。また、送金受取人の実質的支配者は、イラン・北朝鮮に関係ありません。"]
[null,"（仕向国）"]
[null,"「外国為替および外国貿易法」に基づく許可等（要の場合）　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"許可等番号：　\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"許可等日付："]
[null,"ご依頼人英字名\n(APPLICANT)",null,null,null,null,null,null,"（英字大文字）　(FULL NAME IN PRINT)"]
[]
[]
[null,"ご依頼人英字住所\n(APPLICANT'S \nADDRESS)",null,null,null,null,null,null,"（英字大文字）　(FULL ADDRESS IN PRINT)"]
[]
[]
[null,"　　　私（当社）名義の下記口座より、外国送金代わり金および手数料を口座振替により引き落としてください。なお、払戻請求書、小切手の提出は省略いたします。"]
[null,"ご依頼人口座番号\n(APPLICANT'S A/C NO.)",null,null,null,null,null,null,"外国送金代わり金口座",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"手数料口座（左記口座と相違する場合にご記入ください）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印鑑照合"]
[null,null,null,null,null,null,null,null,"店番",null,null,"種別",null,null,null,null,null,null,"口座番号",null,null,null,null,null,null,"お届印",null,null,null,null,null,null,"店番",null,null,"種別",null,null,null,null,null,null,"口座番号",null,null,null,null,null,null,"お届印"]
[]
[]
[]
[]
[null,"「外国送金取引規定」の条項に従い上記送金を依頼します。内国税の適正な課税の確保を図るための国外送金等に係る調書の提出等に関する法律第３条の規定により上記のとおり"]
[null,"告知します。(I/WE REQUEST YOU ABOVE REMITTANCE UNDER THE TERMS AND CONDITIONS OF FOREIGN REMITTANCE TRANSACTIONS.　I/WE HEREBY DECLARE THE REQUIRED"]
[null," ITEMS PURSUANT TO ARTICLE 3 OF THE  \"LAW ON REPORTING REQUIREMENTS ON CROSS BORDER　AND  RECEIPTS PAYMENTS FOR LAW THE TAX COMPLIANCE\" AS ABOVE.)"]
[]
[null,"漢字住所"]
[null,"（ADDRESS)"]
[null,"ご依頼人名(APPLICANT'S NAME & SINGNATURE)  ※ 個人の場合は署名のみご記入ください／法人の場合は記名と押印をお願いします。"]
[]
[]
[]
[]
[null,"日中連絡可能な電話番号(PHONE NO.)　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,"ー"]
[null,"ご来店者",null,null,null,"（ご依頼人との関係）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（お名前）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（勤務先名）"]
[]
[null,"国内の送金依頼人が国税通則法第117条第2項の規定による納税管理人の届出をされている場合、その納税管理人の氏名および住所　　（該当しない場合は記入不要です）"]
[null,"納税管理人氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"納税管理人住所"]
[]
[null,"【受付店使用欄】",null,null,null,null,null,"（　受付店名　　　　　　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【本人確認コードの確認】（僚店含む）　※外為法"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□　本人確認書作成不要（本人確認済）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□　本人確認書作成要（本人確認未済）"]
[null,"【代わり金】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," □１　　□２　　□３　　□確認済（CIFなし）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□８　　□９　　□当行取引なし"]
[null,"□ EX（日本円⇒外貨）　　　　□NON-EX 　　　□予約（No.　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"確認資料"]
[null,"□ 本人口座からの振替　　（口座番号：　　　　　　　　　-　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□面識あり",null,null,null,null,null,"□運転免許証",null,null,null,null,null,"□健康保険証",null,null,null,null,null,"□個人番号カード（番号記録不可）"]
[null,"□ 現金取引（他人口座からの振替含む）（注）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□在留カード",null,null,null,null,null,"□その他（　　　　　　　　　　　　　　　　　　　）"]
[null,null,"（注）現金10万円超の場合、「お取引の目的等の申告のお願い」（PC事括816）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※確認資料番号（　　　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[null,null,"　　　を受入（今回受入）　ただし、本人確認区分更新日がH25.4.1以後の場合を除く",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【資産凍結対象者リスト確認】（確認資料添付保管）"]
[null,"【マイナンバーの受入要否】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"検印",null,null,null,null,null,"確認者印",null,null,null,null,null,null,"（備考）"]
[null,"　（店番・CIF No.　　　　　　　　　　　　-                                                )"]
[null,"□　受入済みの確認（CIFへの紐付確認済）"]
[null,"□　本件にて受入（CIF保有先はCIFへの紐付登録要（注））"]
[null,"□　受入不可　（□　交渉経緯記録済）"]
[null,"　（注）　CIFなし先の場合は、取組番号でマイナンバーの届出を受ける。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国際ビジネス支援部使用欄（決済銀行名：　　　   　　　　　　　　　　　　　　　　　　　　　　　　）"]
[null,"【当局宛報告の該当有無】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"スイフト発信日",null,null,null,null,null,null,null,null,null,null,"検印",null,null,null,null,"資産凍結確認",null,null,null,null,"係印",null,null,null,null,"引落確認"]
[null,"3,000万円相当額超の貿易外取引（居住者間取引を除く）"]
[null,"□該当しない　　　　　　　　　□該当する"]
[null,"※該当の場合、「支払または支払の受領に関する報告書（別紙様式第三」）を受入"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ver 1.3"]