Import verification sheet (application form)

As specified by the State Administration of Foreign Exchange, the verification sheet shall be filled out by the importer when paying the foreign exchange to the foreign clients. The upper part of the verification sheet shall be filled out by the importer as per the specific conditions, while the lower part thereof shall be filled and sealed by the assigned foreign exchange bank. The sealed verification sheet shall be summarized and submitted to the State Administration of Foreign Exchange for cancelling after verification.

Verification sheet issuer’s No.:

Organization code:	Organization name	Name of the local foreign exchange bureau
Name of the bank which makes the payment	Nationality of the receiver	Transaction code
Is the receiver from the bonded area: Yes No	Remark for transaction
Currency used for foreign exchange                                      Foreign exchange amount                                                              Among which: amount of purchase     Amount in FX           Amount of others     Account no. (RMB)                                                               Account no. (foreign currency)
Type of the payment Normal payment Not listed                L/C over 90 days                Collection over 90 days        Payment outside the hometown Arrival over 90 days                     transit trade                     Materials used for the overseas projects    Examining the authenticity Remark No.
Estimated time of arrival / /	Importing batch no.	Contract/ invoice No.
Way of settlement
L/C within 90 days      Over 90 days        Date of acceptance / /         Date of payment / /      Period   days
Collection within 90 days      Over 90 days         Date of acceptance / /         Date of payment / /       Period   days
Down payment                                            C.O.D (subject to the Customs declaration)              date of payment / / Customs declaration no.    date of Customs declaration / / currency used for Customs declaration   amount Customs declaration no.    date of Customs declaration / / currency used for Customs declaration   amount Customs declaration no.    date of Customs declaration / / currency used for Customs declaration   amount Customs declaration no.    date of Customs declaration / / currency used for Customs declaration   amount Customs declaration no.    date of Customs declaration / / currency used for Customs declaration amount (the space could be added for completing the Customs declaration)
Others                date of payment / /
The following items shall be filled out by the bank: Declaration No.: Commercial No.:        Reviewing date: /   /       (Signature and seal of the bank)

Signature and seal of the importer