Branch Stamp Reference No.:
Wire Transfer Order Form
China Wire Domestic International
Amount of Transfer: Amount of Transfer:
Yes, I have an account with Chinatrust Bank (U.S.A.), Account No.:
No, I do not have an account with Chinatrust Bank (U.S.A.) If amount of transfer is $3,000.00 or more, please provide the following information:
Social Security No.: I do not have Social Security Number.
And one of the following I.D.s:
a. Drive’s License #: DOB: State Issued: Expiry:
b. Passport #: DOB: Issuing Country: Issuer: Expiry:
c. Other Government ID #: Type: DOB: Issuer: Expiry:
SOURCE OF PAYMENT/CUSTOMER AUTHORIZATION BENEFICIARY INFORMATION
Debit my Chinatrust Bank (U.S.A.) Account No.:
ORIGINATOR’S INFORMATION Beneficiary’s Account No.:
Phone #: Beneficiary’s ID No.:
INTERMEDIARY BANK (If Applicable) BENEFICIARY BANK
Bank Name: Beneficiary’s Bank:
Bank Address: Bank Address:
Bank Account No.: ABA No./SWIFT BIC:
ABA No./SWIFT BIC:
By signing below, I (we) certify that the information contained herein is true, complete and accurate, of my (our) personal knowledge and that I (we) have
read and agreed to the stipulations and terms detailed on the reverse side of this form.
__________________________ ____ _______________________ _______________________________ _____________________
(Originator’s Signature) (Date) (Originator’s Signature) (Date)
BRANCH USE ONLY
U.S. Dollar: US$ _________________________________________ TCM Log Number: _____________________________________________
Cable Charges: US$ _________________________________________
Foreign Currency: _____________ _________________ _________ _
TOTAL CHARGES: US$ _______________________________________ CCY Amount
Funds Verified Telephone Confirmed Signature Verified Exchange Rate: _______________________________________________
Authorized By: ________________________________________________ USD Equivalent: _______________________________________________
Authorized By: ________________________________________________ Confirmed With: ______________________ By: ___________________
Wire Form 12/04 White Original – Wire Dept Copy. Yellow – Branch Copy. Pink – Customer Copy.
Funds Transfer Agreement
Customer acknowledges that any wire transfer order executed by the Bank will be subject to rules and regulations
applicable to wire transfer orders, including recordkeeping and information transmittal requirements under the
Federal Bank Secrecy Act and its implementing regulations. Customer acknowledges and agrees that the Bank may
capture and transmit information regarding Customer (Customer’s name, account number, address), and regarding
any Beneficiary (Beneficiary’s name, account number, and address) as part of the processing of the Wire Transfer
order. Customer agrees to assist the Bank in connection with any requirements imposed on the Bank in fulfilling the
Bank’s obligations in this regard.
1. Customer (“You”) authorize Chinatrust Bank (U.S.A.) (“US”) to make the funds transfer described on the reverse side
of this form.
2. You agree to indemnify, defend and hold us harmless from any claim, action, loss, and damages that occur if your
payment instructions are incomplete, ambiguous or incorrect. We are not required to seek clarification from anyone
regarding ambiguous instructions. If you identify the Beneficiary, the Beneficiary Bank or an Intermediary Bank by
name and number, payment of your order may be made based on the number alone, even if it identifies a person or
bank different from that shown on the front of this form.
3. We may transfer funds through an Intermediary Bank or funds transfer system which is different from that shown in
4. If we receive your Wire Transfer Order after our processing cutoff hour (1:00 p.m. PST West Coast Branches/3:00
p.m. EST East Coast Branches each business day) or on a Saturday, Sunday or holiday, we may process it on the
next funds-transfer business day. (For the date your wire transfer order will be issued by Chinatrust Bank (U.S.A.),
refer to the Execution Date.) A delay may also occur if the Beneficiary or Intermediary Bank is not accepting wire
transfer orders (e.g., due to a local holiday).
5. You do not have a right to cancel or amend your Wire transfer order after the wire has been sent. You agree to
indemnify, defend and hold us harmless from all actions, losses, claims and damages, however, if we attempt
(successful or otherwise) to comply with any cancellation or amendment request.
6. If your funds transfer is made from an account with us, it will be reflected on your next periodic statement. You will
not receive any additional receipt or notice regarding your transfer. You agree to notify us immediately if you notice
any discrepancy between your statement and this wire transfer order or if you discover a problem with your transfer.
You must send us a written notice of the problem, including a statement of the relevant facts within a reasonable
time (not to exceed 14 calendar days) from the date you first discover the problem or receive a statement or notice
reflecting the erroneous transfer, whichever occurs first. If you fail to do so within 14 days, we will not have to pay
you interest on any amount refundable to you before we learn of the problem.
7. Foreign funds transfers may be subject to delays, charges imposed by other banks, and changes in foreign currency
exchange rates. We may convert foreign currency transfers at our selling rate or the buying rate in effect at the
8. We will not be liable for consequential, special or exemplary damages or losses of any kind. We will not be liable for
any failure to act or delay due to: a lack of sufficient available funds in your account; circumstances beyond our
control; fire, flood or natural disasters; communication failure; labor disputes; any inaccuracy or ambiguity in your
instructions; the action or action of others; or any applicable government or funds-transfer system rule, policy or
regulation. If we cannot complete a transfer for any reason, we will attempt to notify you orally or in writing by the
end of our next banking day.
9. You agree to pay us our funds transfer service fee. If you have an account with us, we may charge the transaction
and our fee to your account.
10. If the foreign currency funds transfer is returned or cancelled, the Customers agrees to accept the refund in US
Dollars in the amount of the foreign money settlement based on the currency buying rate of the bank converting the
currency to US Dollars on the date of the refund or cancellation, less all fees, charges and expense incurred by the
Definitions: Please refer to the definitions of these terms when completing the Wire Transfer Order form.
Originator: Originator means the requestor of the first wire transfer order in a funds transfer order (wire transfer). It is the
person giving the wire instructions.
Bank: Bank is a commercial bank or trust company, a private bank, a savings and loan, a credit union, a thrift
organization, under the law of any state or of the United Sate; a foreign bank organization under foreign law.
Intermediary Bank: An Intermediary Bank is a receiving bank other than the Originator’s Bank or the Beneficiary’s Bank.
It is a bank that receives a wire transfer order with instructions to transmit it to the beneficiary’s bank or another
Beneficiary: Beneficiary means the person to be paid by the beneficiary’s bank.
Beneficiary’s Bank: Beneficiary’s Bank means the bank identified in a wire transfer order in which an account of the
beneficiary is to be credited pursuant to the order or which otherwise is to make payment to the beneficiary if the order
does not provide payment to an account.
Execution Date: Execution Date of a wire transfer order means the day on which the receiving bank (Chinatrust Bank
(U.S.A.) issues a wire transfer order in execution of the originator’s order.