LOCAL US DOLLAR CHEQUE DEPOSIT SLIP  (本地)美元支票存款票據

Date 日期 (dd/mm/yy)Only applicable to US Dollar Cheques drawn in Hong Kong 只適用於在香港提取的美元支票

Cheques 支票

(Please list cheque no. below)(請在下面列明支票號碼)

Total 合計

LOCAL US DOLLAR CHEQUE DEPOSIT SLIP  (本地)美元支票存款票據

Date 日期 (dd/mm/yy)Only applicable to US Dollar Cheques drawn in Hong Kong 只適用於在香港提取的美元支票

Cheques 支票

(Please list cheque no. below)(請在下面列明支票號碼)

Total 合計

LOCAL US DOLLAR CHEQUE DEPOSIT SLIP  (本地)美元支票存款票據

Date 日期 (dd/mm/yy)Only applicable to US Dollar Cheques drawn in Hong Kong 只適用於在香港提取的美元支票

Cheques 支票

(Please list cheque no. below)(請在下面列明支票號碼)

Total 合計

US Dollars 美元

US Dollars 美元

Account Title 戶口名稱

Account No. 戶口號碼

Account Title 戶口名稱

Account No. 戶口號碼

Account No. 戶口號碼

US Dollars 美元Account Title 戶口名稱

Citi

bank

, N.A

., or

gani

zed

unde

r the

law

s of U

.S.A

. with

lim

ited

liabi

lity

Citi

bank

, N.A

., or

gani

zed

unde

r the

law

s of U

.S.A

. with

lim

ited

liabi

lity

Citi

bank

, N.A

., or

gani

zed

unde

r the

law

s of U

.S.A

. with

lim

ited

liabi

lity