WITHDRAWAL REQUEST FORM To withdraw funds or close an account, fill out and sign the Withdrawal Request Form. All open positions must be closed prior to any withdrawals. Please make sure all information below is typed or written clearly and completely to avoid errors or delays in processing. The request will be processed within 2 business days of receipt of this form via US mail to the address above, or via FAX too. CONT ACT INFORMA TION Please type or use BLO CK LE TTERS PAT trading account holder only. PAT may not make or receive payment via third party. Account Number： Client Name：
Passport or ID Card No.：
Issuing Country：
Home Address：
Home Telephone No .:
Mobile Phone No.:
Home Fax No.:
Email Address (Required ):
WITHDRAWAL INFORMATIO N WITHDRAWALINFORMATIO Bank Name ： Bank Address： Bank Account Number ： Bank Account Holder’s Name： SWIFT Code or ABA Number： Withdrawal Amount $USD Will your ac count be closed ? □Yes □No Receive Currency*
Comments, if any _________________________________________________________________
Primary Account Signature:
Joint Account Signature : JointAccount
Trading Agent Signature:
Client Name (English and Chinese):
Client Name (English and Chinese):
Agent Name (English and Chinese):
Date:
Date:
Date:
A PPROVED AND ACCEPTED BY ____________________
Name of A pp roving Officer ────────
Date: