{"text_format":"1","workbook":"xlsx","n_sheets":10,"sheets":["目次","1お願い事項 ","2外国送金取引規定","3国名　英語名シート ","4入力シート","5外国送金依頼書兼告知書","6入力シート（入力例）","7外国送金依頼書兼告知書 直接入力方式","8外国送金依頼書兼告知書 直接入力方式 (入力例)","9入力隠れの対応シート"],"not_rendered":{"charts":0,"images":8,"macros":1,"external_links":0,"defined_names":4,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"目次","index":0,"n_rows":30,"n_cols":7,"rows_kept":30,"cut":false,"hidden":false,"merged":[[5,2,5,3],[6,1,11,1],[12,1,18,1],[19,1,22,1],[23,1,24,1]]}
[]
[]
[null,null,null,"エクセルシートの構成"]
[]
[]
[null,null,"目次",null,"内容　備考",null,"外国送金詐取事案が増加しています。ご注意ください。"]
[null,"共通事項",1,"お願い事項　外国送金取引についてのお願い","共通事項"]
[null,null,null,null,null,null,"（参考）"]
[null,null,2,"外国送金取引規定","共通事項"]
[null,null,null,null,null,null,"・警察庁ウェブサイトでの注意喚起"]
[null,null,3,"国名シート","共通事項",null,"ビジネスメール詐欺に注意！｜警察庁Webサイト"]
[]
[null,"入力シート入力方式で作成する場合に使用",4,"入力シート","入力方式で作成する外国送金依頼書兼告知書の作成シート",null,"・IPA独立行政法人情報処理推進機構セキュリティセンターウェブサイトでの注意喚起"]
[null,null,null,null,"（シート7の入力シート（入力例）を参考に入力ください。）",null,"000068781.pdf"]
[]
[null,null,5,"外国送金依頼書兼告知書","入力方式で作成する外国送金依頼書兼告知書",null,"・米国連邦捜査局（FBI）のインターネット犯罪苦情センター（IC3）ウェブサイトで注意喚起"]
[null,null,null,"(4 入力シートを入力すると自動で入力されます。　このシートからの入力不可）",null,null,"Home Page - Internet Crime Complaint Center (IC3)"]
[null,null,6,"入力シート（入力例）","入力方式で作成する外国送金依頼書兼告知書の入力例"]
[null,null,null,null,null,null,"当行が指定する高リスク国・地域へのご送金は取り扱えません。"]
[null,"直接入力方式で作成する場合に使用",7,"外国送金依頼書兼告知書 直接入力方式","直接入力方式で作成する外国送金依頼書兼告知書",null,"【北朝鮮、イラン、シリア、キューバ、ウクライナのクミリア地域、"]
[null,null,null,null,null,null,"ドネツク、ルハンスク、ベネズエラ、ロシア、ベラルーシ】"]
[null,null,8,"外国送金依頼書兼告知書 直接入力方式 (入力例)","直接入力方式で作成する外国送金依頼書兼告知書の入力例"]
[null,null,null,null,null,null,"中国東北三省の遼寧省、吉林省、黒竜江省、イラク、"]
[null,"共通事項",9,"入力隠れの対応シート","共通事項　　入力隠れの場合の入力シート",null,"トルコ、UAE、サウジアラビア、パキスタン向けの送金の場合は、"]
[null,null,null,null,null,null,"輸入許可通知書を提出ください。"]
[]
[null,null,null,null,null,null,"当行が指定する高リスク品目については、輸入許可通知書を提出ください。"]
[null,null,null,null,null,null,"【あさり、さるとりいばらの葉、けがに、しじみ、エビ、ひらめ、はまぐり、あわび、"]
[null,null,null,null,null,null,"うに、まつたけ、ずわいがに、赤貝、なまこ、かれい、たこ、絨毯、ナッツ、"]
[null,null,null,null,null,null,"ドライフルーツ、タバコ、砂糖、カカオ、鉱物】"]

{"sheet":"1お願い事項 ","index":1,"n_rows":61,"n_cols":3,"rows_kept":61,"cut":false,"hidden":false,"merged":[]}
[]
[null,null,"お客さま各位"]
[]
[null,null,"大光銀行"]
[]
[null,null,"外国送金取引についてのお願い"]
[]
[null,null,"　平素は格別のお引き立てを賜り、厚く御礼申し上げます。"]
[null,null,"　近年、マネー・ローンダリングおよびテロ資金供与対策の重要性がますます高まり、日本および国際社会が"]
[null,null,"取組むべき課題となっております。"]
[null,null,"　大光銀行では、日本の「外国為替及び外国貿易法」等の定める経済制裁規制のほか、米国財務省の外国"]
[null,null,"資産管理局（Office of Foreign Assets Control(以下「OFAC」））による規制等、適用されうるすべての経済"]
[null,null,"制裁関連法令に厳格に準拠する方針としており、これらに抵触する、あるいは抵触するおそれのあるお取引"]
[null,null,"は受付ておりません。"]
[]
[null,null,"以下に該当するまたは該当する懸念のある外国送金取引事務はご依頼できません。"]
[]
[null,null,"（１）経済制裁関連規制（外国為替及び外国貿易法（以下、外為法）、ＯＦＡＣ規制等）違反取引"]
[]
[null,null,"（２）犯罪収益の収受に該当する送金取引"]
[]
[null,null,"（３）詐欺事案等に関連する送金取引"]
[]
[null,null,"（４）禁輸商品購入代金の決済に該当する送金取引"]
[null,null,"　　（麻薬、拳銃、児童ポルノ、ワシントン条約で禁止される動植物等）"]
[]
[null,null,"（５）オンラインカジノ送金に関連する送金取引"]
[]
[null,null,"（６）贈収賄等の不正な資金の授受に関連する可能性のある送金"]
[]
[null,null,"（７）人権侵害、強制労働、売春、臓器売買等に関連する可能性のある送金"]
[]
[null,null,"（８）真の送金人・受取人が別途存在し、その実態が不明もしくはその実態把握が困難な送金取引"]
[null,null,"　　（依頼人が資金移動業者である場合等）"]
[]
[null,null,"（９）仮想通貨の売買、仮想通貨への投資等を目的に実施する送金取引"]
[]
[null,null,"（１０）外為法第１７条に基づく適法性確認義務によって確認が必要な取引で、主務大臣の許可を要する"]
[null,null,"　　　取引である場合に、当該許可を確認できない取引"]
[]
[null,null,"（１１）ＯＦＡＣ規制対象国（または地域）、都市、団体、個人等が関与する取引"]
[null,null,"　　"]
[null,null,"（１２）送金内容に矛盾がある等、真偽に疑義のある送金取引"]
[]
[null,null,"（１３）店頭での現金受付による送金取引"]
[null,null,"　　また、直近１週間以内に送金代り金を振り替える口座に入金された１０百万円以上の現金を送金原資の"]
[null,null,"　　全部または一部とする送金取引は受付できません。"]
[]
[null,null,"（１４）ウクライナ侵攻による対ロシア・ベラルーシ制裁の強化を受け、当行では法令遵守の観点から、ロシア・"]
[null,null,"　　ベラルーシに関連する取引については、当行ポリシーにおいてお取扱いしておりません。"]
[]
[null,null,"　　また、以下の資料のご提出、取引内容の事前のご確認をお願いします。"]
[]
[null,null,"　　北朝鮮関連の『中国東北三省（吉林省、黒竜江省、遼寧省）』、『あさり、さるとりいばらの葉、けがに、しじみ、"]
[null,null,"　　エビ、ひらめ、はまぐり、あわび、うに、まつたけ、ずわいがに、赤貝、なまこ、かれい、たこ』が関連する送金"]
[null,null,"　　の場合、『絨毯』が関連する送金の場合は、輸入許可通知書、原産地証明書等の確証資料の提出をお願い"]
[null,null,"　　します。"]
[]
[null,null,"　　直近１週間以内に送金代り金を振り替える口座に送金金額とほぼ同額またはそれ以上の現金入金がなさ"]
[null,null,"　　れた場合は、他行（庫）通帳や現金の原資となる資料のご提出をお願いします。"]
[null,null,"（2023年4月現在）"]

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{"sheet":"3国名　英語名シート ","index":3,"n_rows":257,"n_cols":4,"rows_kept":257,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
[]
[]
[]
[]
[null,null,"国名・地域名　日本語","国名・地域名　英語名"]
[null,null,"アイスランド","ICELAND"]
[null,null,"アイルランド","IRELAND"]
[null,null,"アゼルバイジャン","AZERBAIJAN"]
[null,null,"アゾレス諸島","AZORES IS."]
[null,null,"アフガニスタン","AFGHANISTN"]
[null,null,"アメリカ合衆国","USA"]
[null,null,"アラブ首長国連邦","U.A.E"]
[null,null,"アルジェリア","ALGERIA"]
[null,null,"アルゼンチン","ARGENTINA"]
[null,null,"アルバ","ARUBA"]
[null,null,"アルバニア","ALBANIA"]
[null,null,"アルメニア","ARMENIA"]
[null,null,"アンギラ","ANGUILLA"]
[null,null,"アンゴラ","ANGOLA"]
[null,null,"アンティグァ・バーブーダ","ANT.BRBD"]
[null,null,"アンドラ","ANDORRA"]
[null,null,"イエメン","YEMEN"]
[null,null,"イギリス","U.K."]
[null,null,"イスラエル","ISRAEL"]
[null,null,"イタリア","ITALY"]
[null,null,"イラク","IRAQ"]
[null,null,"イラン","IRAN"]
[null,null,"インド","INDIA"]
[null,null,"インドネシア","INDONESIA"]
[null,null,"ウガンダ","UGANDA"]
[null,null,"ウクライナ","UKRAINE"]
[null,null,"ウズベキスタン","UZBEKISTAN"]
[null,null,"ウルグアイ","URUGUAY"]
[null,null,"エクアドル","ECUADOR"]
[null,null,"エジプト","EGYPT"]
[null,null,"エストニア","ESTONIA"]
[null,null,"エチオピア","ETHIOPIA"]
[null,null,"エリトリア","ERITREA"]
[null,null,"エルサルバドル","EL SALVAD."]
[null,null,"オーストラリア","AUSTRALIA"]
[null,null,"オーストリア","AUSTRIA"]
[null,null,"オマーン","OMAN"]
[null,null,"オランダ","NETHERLAND"]
[null,null,"ガーナ","GHANA"]
[null,null,"カーボベルデ","CAPE VERDE"]
[null,null,"ガイアナ","GUYANA"]
[null,null,"ガザ・エリコ","GAZA"]
[null,null,"カザフスタン","KAZAKHSTAN"]
[null,null,"カタール","QATAR"]
[null,null,"カナダ","CANADA"]
[null,null,"カナリー諸島","CANARY IS"]
[null,null,"ガボン","GABON"]
[null,null,"カメルーン","CAMEROON"]
[null,null,"カリブ・オランダ","BES IS"]
[null,null,"ガ－ンジィ島","GUERNSEY"]
[null,null,"ガンビア","GAMBIA"]
[null,null,"カンボジア","CAMBODIA"]
[null,null,"ギニア","GUINEA"]
[null,null,"ギニアビサオ","GUINEA-BIS"]
[null,null,"キプロス","CYPRUS"]
[null,null,"キューバ","CUBA"]
[null,null,"キュラソー","CURACAO"]
[null,null,"ギリシャ","GREECE"]
[null,null,"キリバス","KIRIBATI"]
[null,null,"キルギスタン","KYRGYZSTAN"]
[null,null,"グアテマラ","GUATEMALA"]
[null,null,"グアム","GUAM"]
[null,null,"クウェート","KUWAIT"]
[null,null,"クック諸島","COOK IS."]
[null,null,"グリーンランド","GREENLAND"]
[null,null,"クリスマス島","XMAS IS."]
[null,null,"グルジア","GEORGIA"]
[null,null,"グレナダ","GRENADA"]
[null,null,"クロアチア","CROATIA"]
[null,null,"ケニア","KENYA"]
[null,null,"ケルマディック諸島","KERMADC IS"]
[null,null,"コートジボアール","COTEDIVOIR"]
[null,null,"ココス諸島","COCOS IS."]
[null,null,"コスタリカ","COSTA RICA"]
[null,null,"コソボ共和国","KOSOVO"]
[null,null,"コモロ","COMOROS"]
[null,null,"コロンビア","COLOMBIA"]
[null,null,"コンゴ共和国","CONGO REP."]
[null,null,"コンゴ民主共和国(旧ザイール)","CONGO DEMO"]
[null,null,"サウジアラビア","SAUDI ARAB"]
[null,null,"サントメ・プリンシペ","SAO TOME"]
[null,null,"ザンビア","ZAMBIA"]
[null,null,"サンピエール島・ミクロン島","ST.PIERRE"]
[null,null,"サンマリノ","SAN MARINO"]
[null,null,"シエラレオネ","SIERRA LED"]
[null,null,"ジブチ","DJIBOUTI"]
[null,null,"ジブラルタル","GIBRALTAR"]
[null,null,"ジャージー","JERSEY"]
[null,null,"ジャマイカ","JAMAICA"]
[null,null,"シリア","SYRIA"]
[null,null,"シンガポール","SINGAPORE"]
[null,null,"ジンバブエ","ZIMBABWE"]
[null,null,"スイス","SWISS"]
[null,null,"スウェーデン","SWEDEN"]
[null,null,"スーダン","SUDAN"]
[null,null,"スバールバル諸島・ヤンマイエン島","SVALBAR IS"]
[null,null,"スペイン","SPAIN"]
[null,null,"スリナム","SURINAME"]
[null,null,"スリランカ","SRI LANKA"]
[null,null,"スロバキア","SLOVAKIA"]
[null,null,"スロベニア","SLOVENIA"]
[null,null,"スワジランド","SWAZILAND"]
[null,null,"セイシェル","SEYCHELLES"]
[null,null,"セウタ及びメリラ(西)","CEUT MERIR"]
[null,null,"セネガル","SENEGAL"]
[null,null,"セルビア","SERBIA"]
[null,null,"セントクリストファー・ネイビス","ST.CH.NEVI"]
[null,null,"セントビンセントおよびグレナディーン諸島","ST.VINCENT"]
[null,null,"セントヘレナ島","ST.HELENA"]
[null,null,"セントルシア","ST.LUCIA"]
[null,null,"ソマリア","SOMALIA"]
[null,null,"ソロモン諸島","SOLOMON IS"]
[null,null,"タークス諸島・カイコス諸島","TURKS IS."]
[null,null,"タイ","THAILAND"]
[null,null,"タジキスタン","TAJIKISTAN"]
[null,null,"タヒチ","TAHITI"]
[null,null,"タンザニア","TANZANIA"]
[null,null,"チェコ","CZECH"]
[null,null,"チャド","CHAD"]
[null,null,"チュニジア","TUNISIA"]
[null,null,"チリ","CHILE"]
[null,null,"ツバル","TUVALU"]
[null,null,"デンマーク","DENMARK"]
[null,null,"ドイツ","GERMANY"]
[null,null,"トーゴ","TOGO"]
[null,null,"トケラウ諸島","TOKELAU IS"]
[null,null,"ドミニカ共和国","DOMINICAN"]
[null,null,"ドミニカ国","C.DOMINICA"]
[null,null,"トリニダード・トバゴ","TRINIDAD"]
[null,null,"トルクメニスタン","TURKMENSTN"]
[null,null,"トルコ","TURKEY"]
[null,null,"トンガ","TONGA"]
[null,null,"ナイジェリア","NIGERIA"]
[null,null,"ナウル","NAURU"]
[null,null,"ナミビア","NAMIBIA"]
[null,null,"ニウエ","NIUE IS."]
[null,null,"ニカラグア","NICARAGUA"]
[null,null,"ニジェール","NIGER"]
[null,null,"ニューカレドニア","NEW CALEDO"]
[null,null,"ニュージーランド","NEWZEALAND"]
[null,null,"ネパール","NEPAL"]
[null,null,"ノルウェー","NORWAY"]
[null,null,"ハード・マクドナルド諸島","HEARDMC IS"]
[null,null,"バーミューダ","BERMUDA IS"]
[null,null,"バーレーン","BAHRAIN"]
[null,null,"ハイチ","HAITI"]
[null,null,"パキスタン","PAKISTAN"]
[null,null,"バチカン市国","VATICAN"]
[null,null,"パナマ","PANAMA"]
[null,null,"バヌアツ","VANUATU"]
[null,null,"バハマ","BAHAMAS"]
[null,null,"パプアニューギニア","P.NEW GUIN"]
[null,null,"パラオ","PALAU"]
[null,null,"パラグアイ","PARAGUAY"]
[null,null,"バルバドス","BARBADOS"]
[null,null,"パレスチナ","PALESTINE"]
[null,null,"ハンガリー","HUNGARY"]
[null,null,"バングラデシュ","BANGLADESH"]
[null,null,"ピトケアン島","PITECAIRN"]
[null,null,"フィジー","FIJI"]
[null,null,"フィリピン","PHILIPPINE"]
[null,null,"フィンランド","FINLAND"]
[null,null,"ブータン","BHUTAN"]
[null,null,"プエルトリコ","PUERTO RIC"]
[null,null,"フェロー諸島","FAROE IS."]
[null,null,"フォークランド諸島","FALKLAND"]
[null,null,"ブラジル","BRAZIL"]
[null,null,"フランス","FRANCE"]
[null,null,"ブルガリア","BULGARIA"]
[null,null,"ブルキナファソ","BURKINA"]
[null,null,"ブルネイ","BRUNEI"]
[null,null,"ブルンジ","BURUNDI"]
[null,null,"ベトナム","VIETNAM"]
[null,null,"ベナン","BENIN"]
[null,null,"ベネズエラ","VENEZUELA"]
[null,null,"ベラルーシ","BELARUS"]
[null,null,"ベリーズ","BELIZE"]
[null,null,"ペルー","PERU"]
[null,null,"ベルギー","BELGIUM"]
[null,null,"ポーランド","POLAND"]
[null,null,"ボスニア・ヘルツェゴビナ","BOSNIA-HER"]
[null,null,"ボツワナ","BOTSWANA"]
[null,null,"ボリビア","BOLIVIA"]
[null,null,"ポルトガル","PORTUGAL"]
[null,null,"ホンジュラス","HONDURAS"]
[null,null,"マーシャル諸島","MARSHAL IS"]
[null,null,"マカオ","MACAO"]
[null,null,"マケドニア","MACEDONIA"]
[null,null,"マダガスカル","MADAGASCAR"]
[null,null,"マディラ・ケープベルデ諸島","MADEIRA IS"]
[null,null,"マヨット島","MAYOTTE"]
[null,null,"マラウイ","MALAWI"]
[null,null,"マリ","MALI"]
[null,null,"マルタ","MALTA"]
[null,null,"マルチニーク島","MARTINIQUE"]
[null,null,"マレーシア","MALAYSIA"]
[null,null,"マン島","IS.OF MAN"]
[null,null,"ミクロネシア","MICRONESIA"]
[null,null,"ミャンマー","MYANMAR"]
[null,null,"メキシコ","MEXICO"]
[null,null,"モーリシャス","MAURITIUS"]
[null,null,"モーリタニア","MAURITANIA"]
[null,null,"モザンビーク","MOZAMBIQUE"]
[null,null,"モナコ","MONACO"]
[null,null,"モルディブ","MALDIVES"]
[null,null,"モルドバ","MOLDOVA"]
[null,null,"モロッコ","MOROCCO"]
[null,null,"モンゴル","MONGOLIA"]
[null,null,"モンテネグロ","MONTENEGRO"]
[null,null,"モントセラト","MONTSERRAT"]
[null,null,"ヨルダン","JORDAN"]
[null,null,"ラオス","LAOS"]
[null,null,"ラトビア","LATVIA"]
[null,null,"リトアニア","LITHUANIA"]
[null,null,"リビア","LIBYA"]
[null,null,"リヒテンシュタイン","LIECHTEN."]
[null,null,"リベリア","LIBERIA"]
[null,null,"ルーマニア","ROMANIA"]
[null,null,"ルクセンブルク","LUXEMBOURG"]
[null,null,"ルワンダ","RWANDA"]
[null,null,"レソト","LESOTHO"]
[null,null,"レバノン","LEBANON"]
[null,null,"レユニオン","REUNION"]
[null,null,"ロシア連邦","RUSSIA"]
[null,null,"ワリス・フテュナ諸島","WALLIS.FUT"]
[null,null,"英領ケイマン諸島","CAYMAN IS."]
[null,null,"英領バージン諸島","VIRGIN UK"]
[null,null,"韓国","RP.KOREA"]
[null,null,"香港","HONG KONG"]
[null,null,"西サハラ","W.SAHARA"]
[null,null,"西サモア","W.SAMOA"]
[null,null,"赤道ギニア","EQ.GUINEA"]
[null,null,"台湾","TAIWAN"]
[null,null,"中央アフリカ共和国","CEN.AFRICA"]
[null,null,"中国","CHINA"]
[null,null,"朝鮮民主主義人民共和国","DPR.KOREA"]
[null,null,"東ティモール","EAST TIMOR"]
[null,null,"南アフリカ共和国","S.AFRICA"]
[null,null,"南スーダン","S.SUDAN"]
[null,null,"日本","JAPAN"]
[null,null,"仏領ギアナ","GUIANA FR."]
[null,null,"仏領ポリネシア","F.POLYNESI"]
[null,null,"仏領西インド諸島","W.INDIA IS"]
[null,null,"米領サモア","SAMOA"]
[null,null,"米領バージン諸島","VIRGIN USA"]
[null,null,"米領太平洋諸島(ﾐｯﾄﾞｳｪｰ、ｼﾞｮﾝｽﾄﾝ、ｳｪｰｸ島)","MIDWAY IS."]
[null,null,"北マリアナ諸島","N.MARIANA"]
[null,null,"蘭領アンティル","ANTILLES"]
[null,null,"蘭領シント・マールテン","ST.MAARTEN"]

{"sheet":"4入力シート","index":4,"n_rows":249,"n_cols":8,"rows_kept":249,"cut":false,"hidden":false,"merged":[[241,2,246,11],[223,2,223,11],[225,2,225,11],[227,2,227,11],[231,2,232,11],[213,2,214,11],[218,2,218,11],[221,2,221,11],[248,2,248,11],[121,2,122,11],[125,2,126,11],[137,2,138,11],[141,2,142,11],[146,2,147,11],[133,2,134,11],[180,2,181,11],[184,2,185,11],[187,2,187,11],[150,2,151,11],[154,2,155,11],[158,2,159,11],[162,2,163,11],[167,2,169,11],[113,2,113,11],[82,2,83,11],[98,2,98,11],[115,2,116,11],[129,2,130,11],[118,2,118,11],[0,1,0,2],[101,2,102,11],[106,2,107,11],[110,2,111,11],[23,2,24,11],[40,2,42,11],[46,2,48,11],[52,2,55,11],[29,2,31,11],[35,2,36,11],[90,2,91,11],[81,2,81,7],[72,4,72,9],[77,2,78,5],[86,2,87,11],[94,2,94,11],[209,2,209,11],[196,2,196,11],[199,2,199,11],[206,2,206,11],[172,2,173,11],[176,2,177,11],[191,2,192,11]]}
[null,"入力シート",null,null,null,"※　別シートの外国送金取引規定をご確認ください。"]
[]
[null,"入力項目"]
[]
[null,"番号項目"]
[null,1,"依頼日　"]
[null,"西暦",null,"年"]
[]
[null,null,null,"月"]
[]
[null,null,null,"日"]
[]
[null,2,"送金取組日"]
[null,"西暦",null,"年"]
[]
[null,null,null,"月"]
[]
[null,null,null,"日"]
[]
[]
[null,"1★","お客様からのご申告のご確認事項"]
[]
[null,"●","支払等報告書の提出の要・不要の確認"]
[null,null,"送金事由が貿易外取引の場合で、送金金額が円貨換算額/円貨額で3,000万円超となる場合は１．要となります。\nそれ以外の場合は２．不要となります。"]
[]
[null,null,"１．要　　２．不要"]
[null,null,null,null,"←　該当の番号をご入力ください。"]
[]
[null,"●","「外国為替及び外国貿易法」に基づく許可等の要・不要の申告 　　【重要】"]
[null,null,"私/当社は本依頼書の「外国為替及び外国貿易法」に基づく「許可等」が「不要」であること、本件送金が「外国為替及び外国貿易法」の経済制裁対象者に向けたものでないことを以下のとおり確認いたします。"]
[]
[]
[null,null,"１．「必要」かつ経済制裁対象者に向けた送金　２．「不要」かつ経済制裁対象者に向けた送金ではない。"]
[null,null,null,null,"←　該当の番号をご記入ください。"]
[]
[null,null,"「外国為替及び外国貿易法」の北朝鮮・イラン・ロシア関連規制及び「米国OFAC規制」に該当しません。"]
[]
[null,null,"１．該当する　　２．該当しない"]
[null,null,null,null,"←　該当の番号をご入力ください。"]
[]
[null,null,"送金受取人の実質的支配者を含む関係団体・個人は、外為法に基づく資産凍結等の措置の対象となる個人・団体、北朝鮮に住所・居所を有する自然人、北朝鮮に主たる事務所を有する法人その他の団体に該当しません。"]
[]
[]
[null,null,"１．該当する　　２．該当しない"]
[null,null,null,null,"←　該当の番号をご入力ください。"]
[]
[null,null,"外為法に基づく資産凍結等の措置の対象となるロシア・ベラルーシの団体により株式の総数又は出資総額の50％以上を直接所有されている団体への送金に該当しません。"]
[]
[]
[null,null,"１．該当する　　２．該当しない"]
[null,null,null,null,"←　該当の番号をご入力ください。"]
[]
[null,null,"この送金は禁輸商品、オンラインカジノ、贈収賄、強制労働、人権侵害、売春、臓器売買、仮想通貨の売買、仮想通貨への投資等に関連した送金ではありません。また個人の情報等の越境にあたり、移転先の個人情報保護制度等に係る情報の提供を受けました。"]
[]
[]
[]
[null,null,"１．該当する　　２．該当しないかつ　説明を受けた。"]
[null,null,null,null,"←　該当の番号をご入力ください。"]
[]
[null,2,"支払方法"]
[null,null,"　口座振込　のみとなります。"]
[]
[null,3,"支払銀行手数料区分"]
[null,null,"１．お受取人負担",null,null,null,"２．ご依頼人負担"]
[null,null,"(PAYMENT BENEFICIARY)",null,null,null,"(PAYMENT SENDER)"]
[null,null,null,null,"←　該当の番号をご入力ください。"]
[]
[null,4,"決済方法"]
[null,null,"　１．SPOT（直物）　２．NOEX（同通貨）　３．CONT(予約）"]
[null,null,null,"←　該当の番号 1,2,3,のいづれかをご入力ください。"]
[]
[null,5,"送金通貨"]
[null,null,null,null,"←（プルダウンメニューより選択してください。）"]
[null,null,"US$（米ドル）　 /JPY（日本円）　 /EUR（ユーロ）　/STG（イギリスポンド）　/CHF （スイスフラン）　/C$（カナダドル）"]
[null,null,"/A$（オーストラリアドル）　/HK$（香港ドル）　/S$（シンガポールドル）　/THB（タイバーツ）　 /KRW(100)（韓国ウォン）"]
[]
[null,6,"送金金額"]
[null,null,null,null,null,null,null,"補助通貨単位がある場合"]
[null,null,null,null,null,null,null,"ご記入ください。"]
[]
[null,7,"支払銀行・支店（PAYING BANK / BRANCH)　 ※英文・大文字でご入力ください。"]
[null,null,"銀行名"]
[null,null,""]
[]
[]
[null,null,"支店名"]
[null,null,""]
[]
[]
[null,8,"支払銀行住所(PAYING BANK'S ADDRESS)　　※英文・大文字でご入力ください。"]
[null,null,""]
[]
[]
[null,9,"BIC　(SWIFT)　CODE / BIC以外(ABA SORT BSB TRANSIT等）の場合は最初にコード名を明示下さい。（例 ABA : XXXXXXXXX)"]
[null,null,""]
[null,null," (ユーロ圏・英国、その他IBANを必須としている国の場合必ずご入力ください。）"]
[]
[null,10,"国名(COUNTRY)",null,"　←左隣のシートの3.国名 英語名シートを参照ください。"]
[null,null,""]
[]
[null,11,"経由銀行のご指定がある場合のみご入力下さい。※英文・大文字でご入力ください。"]
[null,null,""]
[]
[]
[null,12,"口座番号(BENEFICIARY'S A/C NO.）"]
[null,null," （ユーロ圏・英国の場合は、IBANコード必須）"]
[null,null,""]
[]
[]
[null,13,"お受取人氏名(BENEFICIARY'S NAME)　※英文・大文字でご入力ください。"]
[null,null,""]
[]
[]
[null,14,"お受取人住所(BENEFICIARY'S ADDRESS)　・都市名(CITY)・州名(STATE)・国名(COUNTRY)　　　　"]
[null,null," ※英文・大文字でご入力ください。中国・米国・カナダの場合は省名・都市名　必須　"]
[null,null,""]
[]
[null,null,"(上の入力欄に収まらない場合　↓）",null,null,null,"中国の場合、地級市、県級市等、都市名の入力は必須です。"]
[null,null,""]
[]
[null,null,"省名、州名    ←中国、米国、カナダの場合省名、州名は入力必須です。"]
[null,null,""]
[]
[]
[null,null,"国名(COUNTRY)"]
[null,null,""]
[]
[]
[null,15,"ご依頼人名(APPLICANT'S NAME IN ENGLISH )"]
[null,null,""]
[]
[]
[null,16,"ご依頼人住所(APPLICANT'S ADDRESS）を都道府県、国名まで英文でご入力ください。(ENGLISH)"]
[null,null,""]
[]
[]
[null,null,"国名(COUNTRY)"]
[null,null,""]
[]
[]
[null,17,"送金金額お引出し口座番号(APPLICANT'S A/C NO)"]
[null,null,""]
[]
[]
[null,18,"送金目的(PURPOSE)"]
[null,null,"英語(ENGLISH)"]
[null,null,""]
[]
[]
[null,null,"日本語(JAPANESE)"]
[null,null,""]
[]
[]
[null,19,"原産地（国名）　※英語でご入力ください。"]
[null,null,""]
[]
[]
[null,null,"船積地（都市名）     ※英語でご記入力ください。"]
[null,null,""]
[]
[]
[null,20,"仲介貿易の場合は英語で最終仕向地(国名と都市名）を　英語ご入力ください。"]
[null,null,""]
[]
[]
[null,21,"メッセージ(MESSAGE TO BENEFICIARY) "]
[null,null,"※英語でご入力下さい。"]
[null,null,""]
[]
[]
[]
[null,22,"日中連絡可能な電話番号"]
[null,null,""]
[]
[]
[null,23,"ご送金のご担当者のお名前　　・・・・日本語でご入力ください。"]
[null,null,""]
[]
[]
[null,24,"ご依頼人ご住所(ADDRESS)　　・・・・日本語でご依頼人さまのご住所を都道府県名からご記入ください。"]
[null,null,""]
[]
[]
[null,25,"ご依頼人名　　・・・・日本語で株式会社などの法人種類も含めてご入力ください。"]
[null,null,""]
[]
[null,null,"法人の場合の代表者の肩書、氏名を日本語でご入力下さい。（入力例：代表取締役　大光　太郎）"]
[null,null,""]
[]
[null,26,"送金代り金・諸手数料引落口座"]
[null,null,"ご支店　　　　←（プルダウンメニューより選択してください。）"]
[]
[]
[]
[null,null,"口座種別　　　　　←（プルダウンメニューより選択してください。）"]
[null,null,"普通預金 / 当座預金 / 外貨普通預金"]
[null,null,""]
[]
[null,null,"口座番号"]
[null,null,""]
[null,null,"（外貨普通預金の場合は、N3のあとの６桁を入力）"]
[]
[null,27,"送金代り金が外貨普通預金から引落の場合の手数料引落口座"]
[null,null,"外貨普通預金からの引落でない場合は入力不要です。"]
[null,null,"口座種別　　　　　　　　←（プルダウンメニューより選択してください。）"]
[null,null,"普通預金　/　当座預金　"]
[]
[]
[null,null,"口座番号"]
[null,null,""]
[]
[null,28,"お取引店舗名"]
[null,null,"ご支店　　　　←（プルダウンメニューより選択してください。）"]
[]
[]
[]
[null,29,"貴社電話担当者名"]
[null,null,"ご担当者様名"]
[null,null,""]
[]
[null,30,"依頼番号　①から④で４桁の番号をご入力ください。"]
[null,"①"]
[]
[null,"②"]
[]
[null,"③"]
[]
[null,"④"]
[]
[]
[null,31,"架電時銀行担当者　　銀行担当者名を日本語で入力ください。"]
[]
[]
[]
[]
[null,null,"ご入力　お疲れ様でした。以上で入力は終了です。　上部の印刷　のボタンをクリックして下さい。"]
[null,null,"外国送金依頼書兼告知書が印刷されます。"]
[null,null,"外国送金依頼書兼告知書に押印の上，ＦＡＸしてください。"]
[null,null,"印刷された外国送金依頼書兼告知書の各項目に印刷隠れの項目がないかご確認ください。"]
[null,null,"印刷隠れがある場合は、外国送金依頼書兼告知書シートの該当セルのフォントサイズを変更ください。"]
[null,null,"又は最後のシートの入力隠れの対応シート　に　該当項目の内容を再度ご入力し印刷してご提出をお願いします。"]
[null,null,"この送金の送金代り金および諸手数料は、上記の口座よりお引き落とし下さい。この取扱いにあたっては、各預金規定にかかわらず、払戻請求書または小切手の提出はいたしませんので、貴行所定の方法で取扱いされることに同意します。後日、被仕向銀行より請求される依頼人負担の手数料も、同様とします。送金代り金の引落が外貨普通預金の場合は、項目２７に手数料引落口座を指定します。記載しなかった場合は貴行所定の取扱いに同意します。"]
[]
[]
[]
[]
[]
[]
[null,null,"入力終了セル"]

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[null,null,"株式会社大光銀行　御中\nTO THE TAIKO BANK,LTD.",null,null,null,null,null,null,null,null,null,null,null,null,"外国送金依頼書兼告知書(FAX受付用）\n(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,null,null,null,null,null,null,"REF.NO. 907-P0-                  　 -0"]
[]
[null,null,"外国送金取扱規定に従い、下記送金を依頼します。また、下記の通り「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条に定める告知を行います。"]
[]
[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,"依頼日",null,null,null,{"$f":"IF('4入力シート'!C7=\"\",\"\",'4入力シート'!C7)","v":""},null,null,null,"年",{"$f":"IF('4入力シート'!C9=\"\",\"\",'4入力シート'!C9)","v":""},null,"月",{"$f":"IF('4入力シート'!C11=\"\",\"\",'4入力シート'!C11)","v":""},null,"日","送金取組日",null,null,null,null,null,{"$f":"IF('4入力シート'!C14=\"\",\"\",'4入力シート'!C14)","v":""},null,null,null,"年",{"$f":"IF('4入力シート'!C16=\"\",\"\",'4入力シート'!C16)","v":""},null,"月",{"$f":"IF('4入力シート'!C18=\"\",\"\",'4入力シート'!C18)","v":""},null,"日"]
[]
[]
[null,null,"太枠内を活字体でご記入下さい。また該当する□内に〇印を付けて下さい。"]
[]
[null,null,null,"支払方法（PAYMENT INSTRUCTION)",null,null,null,null,null,"口座振込（ADVISE AND CREDIT)",null,null,null,null,"経由銀行や支払銀行で発生する手数料　　(CHARGES FOR THE BANKS CONCERNED,IF ANY,ARE FOR A/C OF",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF('4入力シート'!C66=1,\"〇\",\"\")","v":""},null,"お受取人負担\n（PAYMENT BENEFICIARY)",null,null,null,null,null,null,null,null,null,null,"※　電文発信は送金取組日（資金引落日）の翌営業日です。"]
[]
[null,null,null,null,null,null,null,"〇"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF('4入力シート'!C66=2,\"〇\",\"\")","v":""},null,"ご依頼人負担\n（PAYMENT SENDER)",null,null,null,null,null,null,null,null,null,null,"決\n済\n方\n法",null,null,null,null,null,null,null,{"$f":"IF('4入力シート'!C70=1,\"〇\",\"\")","v":""},null,"SPOT(直物）",null,null,null,null,null,{"$f":"IF('4入力シート'!C70=2,\"〇\",\"\")","v":""},null,"NOEX\n（同通貨間）",null,null,null,null,null,{"$f":"IF('4入力シート'!C70=3,\"〇\",\"\")","v":""},null,"CONT(予約）"]
[]
[]
[]
[null,null,null,"通貨種類\n(KIND OF CURRENCY)",null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C73),\"\",('4入力シート'!C73))","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,"送金金額(AMOUNT OF REMITTANCE)",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(M22),\"\",(M22))","v":""},null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C78),\"\",'4入力シート'!C78)","v":""}]
[]
[]
[]
[null,null,null,"お受取人","支払銀行（PAYING BANK)",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,"支店（BRANCH)"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C83),\"\",('4入力シート'!C83))","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C87),\"\",'4入力シート'!C87)","v":""}]
[]
[]
[]
[null,null,null,null,"支払銀行住所(PAYING BANK'S ADDRESS)"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C91),\"\",'4入力シート'!C91)","v":""}]
[]
[]
[]
[null,null,null,null,"BIC(SWIFT)CODE  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C95),\"\",'4入力シート'!C95)","v":""},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\n(COUNTRY)",null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C99),\"\",'4入力シート'!C99)","v":""}]
[]
[]
[null,null,null,null,"経由銀行のご指定がある場合のみご記入下さい。"]
[]
[null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C102),\"\",'4入力シート'!C102)","v":""}]
[]
[]
[null,null,null,null,"口座番号(BENEFICIARY'S A/C NO.）",null,null,null,null,null,null,null,null," （ユーロ圏・英国の場合は、IBANコード必須）",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C107),\"\",'4入力シート'!C107)","v":""}]
[]
[]
[]
[]
[null,null,null,null,"氏名(BENEFICIARY'S NAME)"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C111),\"\",'4入力シート'!C111)","v":""}]
[]
[]
[]
[]
[null,null,null,null,"住所(BENEFICIARY'S ADDRESS)　・都市名(CITY)・州名(STATE)・国名(COUNTRY)　　　　中国の場合は省名・都市名　必須"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C116),\"\",'4入力シート'!C116)","v":""}]
[]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C119),\"\",'4入力シート'!C119)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"州・省名(STATE   SHENG/PROVINCE)",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C122),\"\",'4入力シート'!C122)","v":""},null,null,null,null,null,null,null,null,null,null,null,"国名\n(COUNTRY)",null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C126),\"\",'4入力シート'!C126)","v":""}]
[]
[]
[null,null,null,"ご依頼人","ご依頼人名(APPLICANT'S NAME IN ENGLISH )を英文でご記入ください。",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,null,null,null,null,null,null,"送金金額お引出し口座番号(APPLICANT'S A/C NO)"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C130),\"\",'4入力シート'!C130)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C142),\"\",'4入力シート'!C142)","v":""}]
[]
[]
[]
[null,null,null,null,"ご依頼人住所(APPLICANT'S ADDRESS）を都道府県、国名まで英文でご記入ください。"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C134),\"\",'4入力シート'!C134)","v":""}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国名\n(COUNTRY)",null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C138),\"\",'4入力シート'!C138)","v":""}]
[]
[]
[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」に基づく許可等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF('4入力シート'!C34=1,\"〇\",\"\")","v":""},null,"要",null,null,{"$f":"IF('4入力シート'!C34=2,\"〇\",\"\")","v":""},null,"不要",null,null,null,"支払等報告書の提出",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF('4入力シート'!C27=1,\"〇\",\"\")","v":""},null,"要",null,null,{"$f":"IF('4入力シート'!C27=2,\"〇\",\"\")","v":""},null,"不要"]
[]
[]
[null,null,null,null,"要の場合の許可番号　NO(                                              )    日付（DATE                            )",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,"送金目的(PURPOSE)"]
[]
[null,null,null,null,"私/当社は本依頼書の上記「許可等」が「要」と記入した場合を除き、送金が「外国為替及び外国貿易法」の経済制裁対象者に向けたものでないことを確認いたします。\nTHIS REMITTANCE IS NOT DIRECTED TO ANY COUNTRIES OR ANY PERSON CONCERNED UNDER THE UNITED NATIONS' ECONOMIC SANCTION. IN CASE OF TRANSACTIONS REQUIRING ANY PERMISSION,ETC. I/WE SHALL SUBMIT DOCUMETS SHOWING SUCH PERMISSION.",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,"英語(ENGLISH)"]
[]
[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,{"$f":"IF(ISBLANK('4入力シート'!C147),\"\",'4入力シート'!C147)","v":""}]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日本語(JAPANESE)"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C151),\"\",'4入力シート'!C151)","v":""}]
[]
[null,null,null,null,null,{"$f":"IF('4入力シート'!C39=2,\"〇\",\"\")","v":""},null,"「外国為替及び外国貿易法」の北朝鮮・イラン・ロシア関連規制及び「米国OFAC規制」に該当しません。"]
[]
[]
[null,null,null,null,null,{"$f":"IF('4入力シート'!C45=2,\"〇\",\"\")","v":""},null,"送金受取人の実質的支配者を含む関係団体・個人は、外為法に基づく資産凍結等の措置の対象となる個人・団体、北朝鮮に住所・居所を有する自然人、北朝鮮に主たる事務所を有する法人その他の団体に該当しません。",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,"※輸入取引の場合は必ず英語でご記入下さい。"]
[]
[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,null,null,null,null,null,null,null,"原産地（国名）",null,null,null,null,null,null,null,null,null,null,null,"船積地（都市名）"]
[]
[null,null,null,null,null,{"$f":"IF('4入力シート'!C51=2,\"〇\",\"\")","v":""},null,"外為法に基づく資産凍結等の措置の対象となるロシア・ベラルーシの団体により株式の総数又は出資総額の50％以上を直接所有されている団体への送金に該当しません。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C155),\"\",'4入力シート'!C155)","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C159),\"\",'4入力シート'!C159)","v":""}]
[]
[]
[]
[null,null,null,null,null,null,null,"この送金は禁輸商品、オンラインカジノ、贈収賄、強制労働、人権侵害、売春、臓器売買、仮想通貨への投資等に関連した送金ではありません。また個人の情報等の越境にあたり、移転先の個人情報保護制度等に係る情報の提供を受けました。"]
[null,null,null,null,null,{"$f":"IF('4入力シート'!C58=2,\"〇\",\"\")","v":""}]
[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,"仲介貿易の場合は英語で最終仕向地をご記入下さい。",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C163),\"\",'4入力シート'!C163)","v":""}]
[]
[null,null,null,null,null,null,null,"ご参考：全国銀行協会ウェブサイト（https://www.zenginkyo.or.jp/article.tag-f/17491)"]
[]
[null,null,null,null,"　　ご住所(ADDRESS)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"メッセージ(MESSAGE TO BENEFICIARY) ※英語でご記入下さい。（ENGLISH ONLY )"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C181),\"\",'4入力シート'!C181)","v":""},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,{"$f":"IF(ISBLANK('4入力シート'!C168),\"\",'4入力シート'!C168)","v":""}]
[]
[]
[]
[null,null,null,null,"　　ご依頼人署名捺印（または記名押印）(SIGNATURE)"]
[]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C185),\"\",'4入力シート'!C185)","v":""},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,"印鑑(SEAL)",null,null,null,null,null,null,null,null,null,"日中連絡可能な電話番号",null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
[]
[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,"印\n\n\n\n（引落口座のお届印）",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C173),\"\",'4入力シート'!C173)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C177),\"\",'4入力シート'!C177)","v":""}]
[]
[]
[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,"送金代り金が外貨普通預金の場合の諸手数料引落について"]
[null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C188),\"\",'4入力シート'!C188)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送金代り金の引落が外貨普通預金の場合は、以下に手数料引落口座をご指定し右に届出印を押印ください。記載のない場合は当行指定口座とします。後日の依頼人負担の手数料も同様です。口座振替依頼書提出済みの場合は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,"印鑑(SEAL)"]
[]
[null,null,null,null,"送金代り金・諸手数料引落口座",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口座番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"\n\n印\n\n（引落口座のお届印）"]
[]
[null,null,null,null,"支店",null,{"$f":"IF(ISBLANK('4入力シート'!C192),\"\",'4入力シート'!C192)","v":""},null,null,null,null,null,null,"種別",null,{"$f":"IF(ISBLANK('4入力シート'!C197),\"\",'4入力シート'!C197)","v":""},null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C200),\"\",'4入力シート'!C200)","v":""}]
[]
[]
[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,"以下は外貨普通預金から引落時のみ記載　　　　↓"]
[null,null,null,"大光銀行取扱店使用欄","①",null,null,null,"送金元本",null,null,null,null,null,null,null,"円貨換算額　①",null,null,null,null,null,null,null,null,null,null,"送金代り金および諸手数料は、上記の口座よりお引き落とし下さい。この取扱いにあたっては、各預金規定にかかわらず、払戻請求書または小切手の提出はいたしませんので、貴行所定の方法でお取扱いください。後日、被仕向銀行より請求される依頼人負担の手数料も、同様とします。"]
[]
[null,null,null,null,null,"為替\n相場",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,"種別",null,null,null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C207),\"\",'4入力シート'!C207)","v":""},null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C210),\"\",'4入力シート'!C210)","v":""}]
[]
[]
[null,null,null,null,"A","送金手数料\nREMIT.CHG.　　6,000円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お取引店舗名",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C214),\"\",'4入力シート'!C214)","v":""},null,null,null,null,null,null,null,null,null,null,null,"大光銀行使用欄",null,"日付（法令遵守確認）",null,null,null,null,null,null,null,null,null,"検印",null,null,null,null,"係印",null,null,null,null,"外（送Ｆ）３"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"貴社電話連絡\nご担当者名",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C219),\"\",'4入力シート'!C219)","v":""}]
[]
[null,null,null,null,"B","リフティングチャージ\nLIF.CHG.1/20％（MIN2,000円）"]
[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,"①　支払等報告書の提出",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係印"]
[]
[]
[null,null,null,null,"C","支払銀行手数料\nPAYING BANKS.CHG.　3,000円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依頼番号記入欄",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C222),\"\",'4入力シート'!C222)","v":""},null,null,{"$f":"IF(ISBLANK('4入力シート'!C224),\"\",'4入力シート'!C224)","v":""},null,null,{"$f":"IF(ISBLANK('4入力シート'!C226),\"\",'4入力シート'!C226)","v":""},null,null,{"$f":"IF(ISBLANK('4入力シート'!C228),\"\",'4入力シート'!C228)","v":""}]
[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,"要　　・　　　不要"]
[]
[]
[null,null,null,null,"②","手数料合計（A+B+C)\nCHG. TOTAL"]
[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,"②依頼番号照合/申告チェック数「6」の確認/外貨普通預金引落で押印が無い場合の口座振替依頼書提出済みの確認",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係印"]
[]
[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,"架電時銀行担当者名",null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK('4入力シート'!C232),\"\",'4入力シート'!C232)","v":""}]
[null,null,null,null,"①＋②",null,null,"合計額TOTAL AMOUNT\n(①+②）"]

{"sheet":"6入力シート（入力例）","index":6,"n_rows":217,"n_cols":8,"rows_kept":217,"cut":false,"hidden":false,"merged":[[209,2,209,11],[216,2,221,11],[184,2,185,11],[187,2,187,11],[191,2,192,11],[196,2,196,11],[199,2,199,11],[206,2,206,11],[180,2,181,11],[133,2,134,11],[137,2,138,11],[141,2,142,11],[146,2,147,11],[150,2,151,11],[154,2,155,11],[158,2,159,11],[162,2,163,11],[167,2,169,11],[172,2,173,11],[176,2,177,11],[129,2,130,11],[90,2,91,11],[94,2,94,11],[98,2,98,11],[101,2,102,11],[106,2,107,11],[110,2,111,11],[113,2,113,11],[115,2,116,11],[118,2,118,11],[121,2,122,11],[125,2,126,11],[86,2,87,11],[0,1,0,2],[23,2,24,11],[29,2,31,11],[35,2,36,11],[40,2,42,11],[46,2,48,11],[52,2,55,11],[72,4,72,9],[77,2,78,5],[81,2,81,7],[82,2,83,11]]}
[null,"入力シート",null,null,null,"※　別シートの外国送金取引規定をご確認ください。"]
[]
[null,"入力項目"]
[]
[null,"番号項目"]
[null,1,"依頼日　"]
[null,"西暦",2025,"年"]
[]
[null,null,4,"月"]
[]
[null,null,4,"日"]
[]
[null,2,"送金取組日"]
[null,"西暦",2025,"年"]
[]
[null,null,4,"月"]
[]
[null,null,7,"日"]
[]
[]
[null,"1★","お客様からのご申告のご確認事項"]
[]
[null,"●","支払等報告書の提出の要・不要の確認"]
[null,null,"送金事由が貿易外取引の場合で、送金金額が円貨換算額/円貨額で3,000万円超となる場合は１．要となります。\nそれ以外の場合は２．不要となります。"]
[]
[null,null,"１．要　　２．不要"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,"●","「外国為替及び外国貿易法」に基づく許可等の要・不要の申告 　　【重要】"]
[null,null,"私/当社は本依頼書の「外国為替及び外国貿易法」に基づく「許可等」が「不要」であること、本件送金が「外国為替及び外国貿易法」の経済制裁対象者に向けたものでないことを以下のとおり確認いたします。"]
[]
[]
[null,null,"１．「必要」かつ経済制裁対象者に向けた送金　２．「不要」かつ経済制裁対象者に向けた送金ではない。"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,null,"「外国為替及び外国貿易法」の北朝鮮・イラン・ロシア関連規制及び「米国OFAC規制」に該当しません。"]
[]
[null,null,"１．該当する　　２．該当しない"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,null,"送金受取人の実質的支配者を含む関係団体・個人は、外為法に基づく資産凍結等の措置の対象となる個人・団体、北朝鮮に住所・居所を有する自然人、北朝鮮に主たる事務所を有する法人その他の団体に該当しません。"]
[]
[]
[null,null,"１．該当する　　２．該当しない"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,null,"外為法に基づく資産凍結等の措置の対象となるロシア・ベラルーシの団体により株式の総数又は出資総額の50％以上を直接所有されている団体への送金に該当しません。"]
[]
[]
[null,null,"１．該当する　　２．該当しない"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,null,"この送金は禁輸商品、オンラインカジノ、贈収賄、強制労働、人権侵害、売春、臓器売買、仮想通貨の売買、仮想通貨への投資等に関連した送金ではありません。また個人の情報等の越境にあたり、移転先の個人情報保護制度等に係る情報の提供を受けました。"]
[]
[]
[]
[null,null,"１．該当する　　２．該当しないかつ　説明を受けた。"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,2,"支払方法"]
[null,null,"　口座振込　のみとなります。"]
[]
[null,3,"支払銀行手数料区分"]
[null,null,"１．お受取人負担",null,null,null,"２．ご依頼人負担"]
[null,null,"(PAYMENT BENEFICIARY)",null,null,null,"(PAYMENT SENDER)"]
[null,null,2,null,"←　該当の番号をご記入ください。"]
[]
[null,4,"決済方法"]
[null,null,"　１．SPOT（直物）　２．NOEX（同通貨）　３．CONT(予約）"]
[null,null,2,"←　該当の番号 1,2,3,のいづれかをご記入ください。"]
[]
[null,5,"送金通貨"]
[null,null,"US$",null,"←（プルダウンメニューより選択してください。）"]
[null,null,"US$（米ドル）　 /JPY（日本円）　 /EUR（ユーロ）　/STG（イギリスポンド）　/CHF （スイスフラン）　/C$（カナダドル）"]
[null,null,"/A$（オーストラリアドル）　/HK$（香港ドル）　/S$（シンガポールドル）　/THB（タイバーツ）　 /KRW(100)（韓国ウォン）"]
[]
[null,6,"送金金額"]
[null,null,50000,null,null,null,null,"補助通貨単位がある場合"]
[null,null,null,null,null,null,null,"ご記入ください。"]
[]
[null,7,"支払銀行・支店（PAYING BANK / BRANCH)　　※英文・大文字でご記入ください。"]
[null,null,"銀行名"]
[null,null,"BANK OF CHINA"]
[]
[]
[null,null,"支店名"]
[null,null,"SHANGHAI BARANCH"]
[]
[]
[null,8,"支払銀行住所(PAYING BANK'S ADDRESS)　　※英文・大文字でご記入ください。"]
[null,null,"200 MID. YINCHENG RD.,PUDONG NEW DISTRICT, SHANGHAI 200121, CHINA"]
[]
[]
[null,9,"BIC　(SWIFT)　CODE "]
[null,null,"BKCH CN BJ 300"]
[null,null," (ユーロ圏・英国、その他IBANを必須としている国の場合必ずご記入ください。）"]
[]
[null,10,"国名(COUNTRY)",null,"　←右隣のシートの国名　英語名シートを参照ください。"]
[null,null,"CHINA"]
[]
[null,11,"経由銀行のご指定がある場合のみご記入下さい。　※英文・大文字でご記入ください。"]
[null,null,""]
[]
[]
[null,12,"口座番号(BENEFICIARY'S A/C NO.）"]
[null,null," （ユーロ圏・英国の場合は、IBANコード必須）"]
[null,null,"523852511"]
[]
[]
[null,13,"お受取人氏名(BENEFICIARY'S NAME)　"]
[null,null,"CHINA TRADING CO.,LTD."]
[]
[]
[null,14,"お受取人住所(BENEFICIARY'S ADDRESS)　・都市名(CITY)・州名(STATE)・国名(COUNTRY)　　　　"]
[null,null," ※英文・大文字でご記入ください。中国・米国・カナダの場合は省名・都市名　必須　"]
[null,null,"NO.33 ZONE C3 XINGHAI SQUARE "]
[]
[null,null,"(上の入力に収まらない場合　↓）",null,null,null,"中国の場合、地級市、県級市等、都市名の入力は必須です。"]
[null,null,""]
[]
[null,null,"省名、州名    ←中国、米国、カナダの場合省名、州名は入力必須です。"]
[null,null,"SHANGHAI"]
[]
[]
[null,null,"国名(COUNTRY)"]
[null,null,"CHINA"]
[]
[]
[null,15,"ご依頼人名(APPLICANT'S NAME IN ENGLISH )"]
[null,null,"TAIKO TRADING CO.,LTD."]
[]
[]
[null,16,"ご依頼人住所(APPLICANT'S ADDRESS）を都道府県、国名まで英文でご記入ください。(ENGLISH)"]
[null,null,"1-5-8　OTE-DORI NAGAOKA CITY  NIIGATA PREF  JAPAN"]
[]
[]
[null,null,"国名(COUNTRY)"]
[null,null,"JAPAN"]
[]
[]
[null,17,"送金金額お引出し口座番号(APPLICANT'S A/C NO)"]
[null,null,"00005X"]
[]
[]
[null,18,"送金目的(PURPOSE)"]
[null,null,"英語(ENGLISH)"]
[null,null,"PAYMENT OF CAMERA PARTS"]
[]
[]
[null,null,"日本語(JAPANESE)"]
[null,null,"カメラ部品支払"]
[]
[]
[null,19,"原産地（国名）"]
[null,null,"CHINA"]
[]
[]
[null,null,"船積地（都市名）      ←　前払いの場合は、ADVANCED PAYMENT とご記入下さい。"]
[null,null,"SHANGHAI"]
[]
[]
[null,20,"仲介貿易の場合は英語で最終仕向地(国名と都市名）をご記入下さい。"]
[null,null,""]
[]
[]
[null,21,"メッセージ(MESSAGE TO BENEFICIARY) "]
[null,null,"※英語でご記入下さい。"]
[null,null,"INV 20230506"]
[]
[]
[]
[null,22,"日中連絡可能な電話番号"]
[null,null,"090-XXXX-X852"]
[]
[]
[null,23,"ご送金のご担当者のお名前　　・・・・日本語でご記入ください。"]
[null,null,"大光　次郎"]
[]
[]
[null,24,"ご依頼人ご住所(ADDRESS)　　・・・・送金依頼人さまのご住所を日本語で都道府県名からご記入ください。"]
[null,null,"新潟県長岡市大手通　1-5-8"]
[]
[]
[null,25,"ご依頼人名　　・・・・日本語で株式会社などの法人種類も含めてご記入ください。"]
[null,null,"株式会社　大光商事"]
[]
[null,null,"法人の場合の代表者の肩書、氏名をご記入下さい。（入力例：代表取締役　大光　太郎）"]
[null,null,"代表取締役　大光　太郎"]
[]
[null,26,"送金代り金・諸手数料引落口座"]
[null,null,"ご支店　　　　←（プルダウンメニューより選択してください。）"]
[null,null,"三条"]
[]
[]
[null,null,"口座種別　　　　　←（プルダウンメニューより選択してください。）"]
[null,null,"普通預金 / 当座預金 / 外貨普通預金"]
[null,null,"外貨普通預金"]
[]
[null,null,"口座番号"]
[null,null,"0000ＸＸ"]
[null,null,"（外貨普通預金の場合は、N3のあとの６桁を入力）"]
[]
[null,27,"送金代り金が外貨普通預金から引落の場合の手数料引落口座"]
[null,null,"外貨普通預金からの引落でない場合は入力不要です。"]
[null,null,"口座種別　　　　　　　　←（プルダウンメニューより選択してください。）"]
[null,null,"普通預金　/　当座預金　"]
[null,null,"普通預金"]
[]
[null,null,"口座番号"]
[null,null,"ＸＸ52ＸＸＸ"]
[]
[null,null,"上の右側のボタン【印刷（外国送金依頼書兼告知書を印刷）】ボタンを押下すると"]
[null,null,"外国送金依頼書兼告知書と外国送金依頼書兼告知書（お客様控え）が印刷されます。"]
[null,null,"印刷された外国送金依頼書兼告知書の各項目に印刷隠れの項目がないかご確認ください。"]
[null,null,"印刷隠れがある場合は、最後のシートの入力隠れの対応シート　に　該当項目の内容を再度"]
[null,null,"ご入力し印刷してご提出をお願いします。"]
[null,null,"この送金の送金代り金および諸手数料は、上記の口座よりお引き落とし下さい。この取扱いにあたっては、各預金規定にかかわらず、払戻請求書または小切手の提出はいたしませんので、貴行所定の方法で取扱いされることに同意します。後日、被仕向銀行より請求される依頼人負担の手数料も、同様とします。送金代り金の引落が外貨普通預金の場合は、項目２７に手数料引落口座を指定します。記載しなかった場合は貴行所定の取扱いに同意します。"]

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[null,null,"株式会社大光銀行　御中\nTO THE TAIKO BANK,LTD.",null,null,null,null,null,null,null,null,null,null,null,null,"外国送金依頼書兼告知書（FAX受付用）\n(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,"直接入力方式"]
[]
[]
[]
[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,"REF.NO. 907-P0-                  　 -0"]
[]
[null,null,"外国送金取扱規定に従い、下記送金を依頼します。また、下記の通り「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条に定める告知を行います。"]
[]
[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,"依頼日\n（西暦）",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","送金取組日\n（西暦）",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[null,null,"太枠内を活字体でご記入下さい。また該当する□内に〇印を付けて下さい。"]
[]
[null,null,null,"支払方法（PAYMENT INSTRUCTION)",null,null,null,null,null,"口座振込（ADVISE AND CREDIT)",null,null,null,null,"経由銀行や支払銀行で発生する手数料(CHARGES FOR THE BANKS CONCERNED,IF ANY,ARE FOR A/C OF",null,null,null,null,null,null,null,null,null,null,null,null,null,"お受取人負担\n（PAYMENY BENEFICIARY)",null,null,null,null,null,null,null,null,null,null,"※　電文発信は送金取組日（資金引落日）の翌営業日です。"]
[]
[null,null,null,null,null,null,null,"〇"]
[]
[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,"ご依頼人負担\n（PAYMENT SENDER)",null,null,null,null,null,null,null,null,null,null,"決\n済\n方\n法",null,null,null,null,null,null,null,null,null,"SPOT(直物）",null,null,null,null,null,null,null,"NOEX\n（同通貨間）",null,null,null,null,null,null,null,"CONT(予約）"]
[]
[]
[]
[null,null,null,"通貨種類\n(KIND OF CURRENCY)\n【プルダウンより選択】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送金金額(AMOUNT OF REMITTANCE)",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(M22),\"\",(M22))","v":""}]
[]
[]
[]
[null,null,null,"お受取人","支払銀行（PAYING BANK)",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,"支店（BRANCH)"]
[]
[]
[]
[]
[]
[null,null,null,null,"支払銀行住所(PAYING BANK'S ADDRESS)"]
[]
[]
[]
[]
[]
[null,null,null,null,"BIC(SWIFT)CODE  (ユーロ圏・英国の場合、必須）",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,"国名\n(COUNTRY)"]
[]
[]
[null,null,null,null,"経由銀行のご指定がある場合のみご記入下さい。"]
[]
[]
[]
[]
[null,null,null,null,"口座番号(BENEFICIARY'S A/C NO.）",null,null,null,null,null,null,null,null," （ユーロ圏・英国の場合は、IBANコード必須）",null,null,null,null,null,null,null,null,null,null,""]
[]
[]
[]
[]
[null,null,null,null,"氏名(BENEFICIARY'S NAME)"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,"住所(BENEFICIARY'S ADDRESS)　・都市名(CITY)・州名(STATE)・国名(COUNTRY)　　　　中国の場合は省名・都市名　必須"]
[]
[]
[]
[]
[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・省名(STATE   SHENG/PROVINCE)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"国名\n(COUNTRY)"]
[]
[]
[null,null,null,"ご依頼人","ご依頼人名(APPLICANT'S NAME IN ENGLISH )を英文でご記入ください。",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,null,null,null,null,null,null,"送金金額お引出し口座番号(APPLICANT'S A/C 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,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,"ご依頼人住所(APPLICANT'S ADDRESS）を都道府県、国名まで英文でご記入ください。"]
[]
[]
[]
[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,null,null,null,null,null,null,null,null,null,"国名\n(COUNTRY)"]
[]
[]
[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」に基づく許可等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"要",null,null,null,null,"不要",null,null,null,"支払等報告書の提出",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"要",null,null,null,null,"不要"]
[]
[]
[null,null,null,null,"要の場合の許可番号　NO(                                              )    日付（DATE                            )",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,"送金目的(PURPOSE)"]
[]
[null,null,null,null,"私/当社は本依頼書の上記「許可等」が「要」と記入した場合を除き、送金が「外国為替及び外国貿易法」の経済制裁対象者に向けたものでないことを確認いたします。\nTHIS REMITTANCE IS NOT DIRECTED TO ANY COUNTRIES OR ANY PERSON CONCERNED UNDER THE UNITED NATIONS' ECONOMIC SANCTION. IN CASE OF TRANSACTIONS REQUIRING ANY PERMISSION,ETC. I/WE SHALL SUBMIT DOCUMETS SHOWING SUCH PERMISSION.",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,"英語(ENGLISH)"]
[]
[]
[]
[]
[]
[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,"日本語(JAPANESE)"]
[]
[]
[]
[null,null,null,null,null,null,null,"「外国為替及び外国貿易法」の北朝鮮・イラン・ロシア関連規制及び「米国OFAC規制」に該当しません。"]
[]
[]
[null,null,null,null,null,null,null,"送金受取人の実質的支配者を含む関係団体・個人は、外為法に基づく資産凍結等の措置の対象となる個人・団体、北朝鮮に住所・居所を有する自然人、北朝鮮に主たる事務所を有する法人その他の団体に該当しません。",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,"※輸入取引の場合は必ず英語でご記入下さい。"]
[]
[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,null,null,null,null,null,null,null,"原産地（国名）",null,null,null,null,null,null,null,null,null,null,null,"船積地（都市名）"]
[]
[null,null,null,null,null,null,null,"外為法に基づく資産凍結等の措置の対象となるロシア・ベラルーシの団体により株式の総数又は出資総額の50％以上を直接所有されている団体への送金に該当しません。"]
[]
[]
[]
[null,null,null,null,null,null,null,"この送金は禁輸商品、オンラインカジノ、贈収賄、強制労働、人権侵害、売春、臓器売買、仮想通貨への投資等に関連した送金ではありません。また個人の情報等の越境にあたり、移転先の個人情報保護制度等に係る情報の提供を受けました。"]
[]
[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,"仲介貿易の場合は英語で最終仕向地をご記入下さい。"]
[]
[null,null,null,null,null,null,null,"ご参考：全国銀行協会ウェブサイト（https://www.zenginkyo.or.jp/article.tag-f/17491)"]
[]
[null,null,null,null,"　　ご住所(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,null,null,null,null,"メッセージ(MESSAGE TO BENEFICIARY) ※英語でご記入下さい。（ENGLISH ONLY )"]
[]
[]
[]
[]
[]
[null,null,null,null,"　　ご依頼人署名捺印（または記名押印）(SIGNATURE)"]
[]
[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,"印鑑(SEAL)",null,null,null,null,null,null,null,null,null,"日中連絡可能な電話番号",null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
[]
[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,"印\n\n\n\n（引落口座のお届印）"]
[]
[]
[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,"送金代り金が外貨普通預金の場合の諸手数料引落について"]
[]
[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,"送金代り金の引落が外貨普通預金の場合は、以下に手数料引落口座をご指定し右に届出印を押印ください。記載のない場合は当行指定口座とします。後日の依頼人負担の手数料も同様です。口座振替依頼書提出済みの場合は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,"印鑑(SEAL)"]
[]
[null,null,null,null,"送金代り金・諸手数料引落口座（プルダウンで選択）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,"\n\n印\n\n（引落口座のお届印）"]
[]
[null,null,null,null,"支店",null,null,null,null,null,null,null,null,"種別",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,"以下は外貨普通預金から引落時のみ記載　　　　↓"]
[null,null,null,"大光銀行取扱店使用欄","①",null,null,null,"送金元本",null,null,null,null,null,null,null,"円貨換算額　①",null,null,null,null,null,null,null,null,null,null,"送金代り金および諸手数料は、上記の口座よりお引き落とし下さい。この取扱いにあたっては、各預金規定にかかわらず、払戻請求書または小切手の提出はいたしませんので、貴行所定の方法でお取扱いください。後日、被仕向銀行より請求される依頼人負担の手数料も、同様とします。"]
[]
[null,null,null,null,null,"為替\n相場",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,"種別（プルダウンで選択）",null,null,null,null,null,null,null,null,null,"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,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,"A","送金手数料\nREMIT.CHG.　　6,000円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お取引店舗名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"大光銀行使用欄",null,"日付（法令遵守確認）",null,null,null,null,null,null,null,null,null,"検印",null,null,null,null,"係印",null,null,null,null,"外（送F）3 直"]
[]
[]
[]
[]
[]
[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,"貴社電話連絡\nご担当者名"]
[]
[null,null,null,null,"B","リフティングチャージ\nLIF.CHG.1/20％（MIN2,000円）"]
[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,"①　支払等報告書の提出",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係印"]
[]
[]
[null,null,null,null,"C","支払銀行手数料\nPAYING BANKS.CHG.　3,000円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依頼番号記入欄"]
[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,"要　　・　　　不要"]
[]
[]
[null,null,null,null,"②","手数料合計（A+B+C)\nCHG. TOTAL"]
[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,"②依頼番号照合/申告チェック数「6」の確認/外貨普通預金引落で押印が無い場合の口座振替依頼書提出済みの確認",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係印"]
[]
[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,"架電時銀行担当者名"]
[null,null,null,null,"①＋②",null,null,"合計額TOTAL AMOUNT\n(①+②）"]

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[null,null,"株式会社大光銀行　御中\nTO THE TAIKO BANK,LTD.",null,null,null,null,null,null,null,null,null,null,null,null,"外国送金依頼書兼告知書(FAX受付用）\n(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,"直接入力方式　入力例"]
[]
[]
[]
[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,"REF.NO. 907-P0-                  　 -0"]
[]
[null,null,"外国送金取扱規定に従い、下記送金を依頼します。また、下記の通り「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条に定める告知を行います。"]
[]
[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,"依頼日\n（西暦）",null,null,null,2025,null,null,null,"年",4,null,"月",4,null,"日","送金取組日\n（西暦）",null,null,null,null,null,2025,null,null,null,"年",4,null,"月",7,null,"日"]
[]
[]
[null,null,"太枠内を活字体でご記入下さい。また該当する□内に〇印を付けて下さい。"]
[]
[null,null,null,"支払方法（PAYMENT INSTRUCTION)",null,null,null,null,null,"口座振込（ADVISE AND CREDIT)",null,null,null,null,"経由銀行や支払銀行で発生する手数料(CHARGES FOR THE BANKS CONCERNED,IF ANY,ARE FOR A/C OF",null,null,null,null,null,null,null,null,null,null,null,null,null,"お受取人負担\n（PAYMENY BENEFICIARY)",null,null,null,null,null,null,null,null,null,null,"※　電文発信は送金取組日（資金引落日）の翌営業日です。"]
[]
[null,null,null,null,null,null,null,"〇"]
[]
[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,"〇",null,"ご依頼人負担\n（PAYMENT SENDER)",null,null,null,null,null,null,null,null,null,null,"決\n済\n方\n法",null,null,null,null,null,null,null,"〇",null,"SPOT(直物）",null,null,null,null,null,null,null,"NOEX\n（同通貨間）",null,null,null,null,null,null,null,"CONT(予約）"]
[]
[]
[]
[null,null,null,"通貨種類\n(KIND OF CURRENCY)\n【プルダウンより選択】",null,null,null,null,null,null,null,null,"US$",null,null,null,null,null,null,null,null,null,null,null,null,null,"送金金額(AMOUNT OF REMITTANCE)",null,null,null,null,null,null,null,null,null,null,{"$f":"IF(ISBLANK(M22),\"\",(M22))","v":"US$"},null,null,null,null,55400]
[]
[]
[]
[null,null,null,"お受取人","支払銀行（PAYING BANK)",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,"支店（BRANCH)"]
[]
[null,null,null,null,"BANK OF XXXX",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," XIANMEN BRANCH"]
[]
[]
[]
[null,null,null,null,"支払銀行住所(PAYING BANK'S ADDRESS)"]
[]
[null,null,null,null,"NO.11 XX ROAD XX STREET  XIAMEN FUJIAN  FUJIAN PROVINCE"]
[]
[]
[]
[null,null,null,null,"BIC(SWIFT)CODE  (ユーロ圏・英国の場合、必須）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CHWWWXX33",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\n(COUNTRY)",null,null,null,null,null,null,"CHINA"]
[]
[]
[null,null,null,null,"経由銀行のご指定がある場合のみご記入下さい。"]
[]
[]
[]
[]
[null,null,null,null,"口座番号(BENEFICIARY'S A/C NO.）",null,null,null,null,null,null,null,null," （ユーロ圏・英国の場合は、IBANコード必須）",null,null,null,null,null,null,null,null,null,null,1222999334]
[]
[]
[]
[]
[null,null,null,null,"氏名(BENEFICIARY'S NAME)"]
[]
[null,null,null,null,"XYZ STONE CORPORATION"]
[]
[]
[]
[]
[null,null,null,null,"住所(BENEFICIARY'S ADDRESS)　・都市名(CITY)・州名(STATE)・国名(COUNTRY)　　　　中国の場合は省名・都市名　必須"]
[]
[null,null,null,null,"NO.22 YY ROAD YY STREET  XIAMEN "]
[]
[]
[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・省名(STATE   SHENG/PROVINCE)",null,null,null,null,null,null,null,null,null,"FUJIAN PROVINCE",null,null,null,null,null,null,null,null,null,null,null,"国名\n(COUNTRY)",null,null,null,null,null,null,"CHINA"]
[]
[]
[null,null,null,"ご依頼人","ご依頼人名(APPLICANT'S NAME IN ENGLISH )を英文でご記入ください。",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,null,null,null,null,null,null,"送金金額お引出し口座番号(APPLICANT'S A/C NO)"]
[]
[null,null,null,null,"TAIKO TRDING CO.,LTD.",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,"XX2222"]
[]
[]
[]
[null,null,null,null,"ご依頼人住所(APPLICANT'S ADDRESS）を都道府県、国名まで英文でご記入ください。"]
[]
[null,null,null,null,"1-2-3  OTE DORI NAGAOKA CITY  NIIGATA PREF "]
[]
[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,"国名\n(COUNTRY)",null,null,null,null,null,null,"JAPAN"]
[]
[]
[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」に基づく許可等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"要",null,null,"〇",null,"不要",null,null,null,"支払等報告書の提出",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"要",null,null,"〇",null,"不要"]
[]
[]
[null,null,null,null,"要の場合の許可番号　NO(                                              )    日付（DATE                            )",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,"送金目的(PURPOSE)"]
[]
[null,null,null,null,"私/当社は本依頼書の上記「許可等」が「要」と記入した場合を除き、送金が「外国為替及び外国貿易法」の経済制裁対象者に向けたものでないことを確認いたします。\nTHIS REMITTANCE IS NOT DIRECTED TO ANY COUNTRIES OR ANY PERSON CONCERNED UNDER THE UNITED NATIONS' ECONOMIC SANCTION. IN CASE OF TRANSACTIONS REQUIRING ANY PERMISSION,ETC. I/WE SHALL SUBMIT DOCUMETS SHOWING SUCH PERMISSION.",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,"英語(ENGLISH)"]
[]
[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,"PAYMENT OF STONE"]
[]
[]
[]
[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,"日本語(JAPANESE)"]
[]
[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,"石材輸入代金支払"]
[]
[null,null,null,null,null,"〇",null,"「外国為替及び外国貿易法」の北朝鮮・イラン・ロシア関連規制及び「米国OFAC規制」に該当しません。"]
[]
[]
[null,null,null,null,null,"〇",null,"送金受取人の実質的支配者を含む関係団体・個人は、外為法に基づく資産凍結等の措置の対象となる個人・団体、北朝鮮に住所・居所を有する自然人、北朝鮮に主たる事務所を有する法人その他の団体に該当しません。",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,"※輸入取引の場合は必ず英語でご記入下さい。"]
[]
[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,null,null,null,null,null,null,null,"原産地（国名）",null,null,null,null,null,null,null,null,null,null,null,"船積地（都市名）"]
[]
[null,null,null,null,null,"〇",null,"外為法に基づく資産凍結等の措置の対象となるロシア・ベラルーシの団体により株式の総数又は出資総額の50％以上を直接所有されている団体への送金に該当しません。",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,"CHINA",null,null,null,null,null,null,null,null,null,null,null,"XIAMEN"]
[]
[]
[]
[null,null,null,null,null,null,null,"この送金は禁輸商品、オンラインカジノ、贈収賄、強制労働、人権侵害、売春、臓器売買、仮想通貨への投資等に関連した送金ではありません。また個人の情報等の越境にあたり、移転先の個人情報保護制度等に係る情報の提供を受けました。"]
[null,null,null,null,null,"〇"]
[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,"仲介貿易の場合は英語で最終仕向地をご記入下さい。"]
[]
[null,null,null,null,null,null,null,"ご参考：全国銀行協会ウェブサイト（https://www.zenginkyo.or.jp/article.tag-f/17491)"]
[]
[null,null,null,null,"　　ご住所(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,null,null,null,null,"メッセージ(MESSAGE TO BENEFICIARY) ※英語でご記入下さい。（ENGLISH ONLY )"]
[]
[null,null,null,null,"新潟県長岡市大手1-2-3",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,"INV NO XX55"]
[]
[]
[]
[null,null,null,null,"　　ご依頼人署名捺印（または記名押印）(SIGNATURE)"]
[]
[null,null,null,null,"株式会社　大光商事",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,"印鑑(SEAL)",null,null,null,null,null,null,null,null,null,"日中連絡可能な電話番号",null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
[]
[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,"印\n\n\n\n（引落口座のお届印）",null,null,null,null,null,null,null,null,null,"0258-40-ＸＸＸＸ",null,null,null,null,null,null,null,null,null,null,null,null,"大光　次郎"]
[]
[]
[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,"送金代り金が外貨普通預金の場合の諸手数料引落について"]
[null,null,null,null,"代表取締役　大光　太郎"]
[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,"送金代り金の引落が外貨普通預金の場合は、以下に手数料引落口座をご指定し右に届出印を押印ください。記載のない場合は当行指定口座とします。後日の依頼人負担の手数料も同様です。口座振替依頼書提出済みの場合は不要です。",null,null,null,null,null,null,null,null,null,null,null,null,"印鑑(SEAL)"]
[]
[null,null,null,null,"送金代り金・諸手数料引落口座（プルダウンで選択）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,"\n\n印\n\n（引落口座のお届印）"]
[]
[null,null,null,null,"支店",null,"三条",null,null,null,null,null,null,"種別",null,"外貨普通預金",null,null,null,null,null,null,null,"Ｘ00055Ｘ"]
[]
[]
[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,"以下は外貨普通預金から引落時のみ記載　　　　↓"]
[null,null,null,"大光銀行取扱店使用欄","①",null,null,null,"送金元本",null,null,null,null,null,null,null,"円貨換算額　①",null,null,null,null,null,null,null,null,null,null,"送金代り金および諸手数料は、上記の口座よりお引き落とし下さい。この取扱いにあたっては、各預金規定にかかわらず、払戻請求書または小切手の提出はいたしませんので、貴行所定の方法でお取扱いください。後日、被仕向銀行より請求される依頼人負担の手数料も、同様とします。"]
[]
[null,null,null,null,null,"為替\n相場",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,"種別（プルダウンで選択）",null,null,null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"普通預金",null,null,null,null,null,null,null,null,null,"XX52145XX"]
[]
[]
[null,null,null,null,"A","送金手数料\nREMIT.CHG.　　6,000円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お取引店舗名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"大光銀行使用欄",null,"日付（法令遵守確認）",null,null,null,null,null,null,null,null,null,"検印",null,null,null,null,"係印"]
[]
[]
[]
[]
[]
[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,"貴社電話連絡ご担当者名"]
[]
[null,null,null,null,"B","リフティングチャージ\nLIF.CHG.1/20％（MIN2,000円）"]
[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,"①　支払等報告書の提出",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係印"]
[]
[]
[null,null,null,null,"C","支払銀行手数料\nPAYING BANKS.CHG.　3,000円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依頼番号記入欄"]
[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,"要　　・　　　不要"]
[]
[]
[null,null,null,null,"②","手数料合計（A+B+C)\nCHG. TOTAL"]
[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,"②依頼番号照合/申告チェック数「6」の確認/外貨普通預金引落で押印が無い場合の口座振替依頼書提出済みの確認",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"係印"]
[]
[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,"架電時銀行担当者名"]
[null,null,null,null,"①＋②",null,null,"合計額TOTAL AMOUNT\n(①+②）"]

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[]
[null,null,"入力内容を印刷したときに内容が隠れてしまう場合の追加依頼書"]
[]
[]
[null,"上段に隠れた部分の項目名を入力ください。　（例：支払銀行住所）"]
[null,"下段に隠れた部分の項目を再度全て入力ください。"]
[null,null,null,null,"金額"]