International Wire Request Form
国际汇款授权表格
（表格請用英文填寫）
Firstrade Account Number:
Firstrade Account Name:
Daytime Telephone Number:
第一理財帳戶號碼
第一理財帳戶姓名
日間聯絡電話
_________________________
____________________________
____________________________
Wire Amount: USD $
____________________________
匯款金額（以美元計算）
*The name of the beneficiary must match the name on the Firstrade account. 匯款受益人的姓名必須與您第一理財帳戶姓名相同。
* We may contact you to verify information prior to processing the request for security reasons. 我們可能會與您連絡確認您的匯款要求。
1. Beneficiary Information 最終收款人信息: (This is the ultimate recipient of the wire transfer funds.)
Beneficiary:
收款人姓名
_______________________________________________________________________
Beneficiary Account Number (or IBAN #):
收款人在收款銀行的帳戶號碼
_________________________________________________
Beneficiary Address, City, State, Zip, Country: (Required) 收款人地址，城市、州、 郵遞區號及國家 （必填）
___________________________________________________________________________________
2. Beneficiary Bank Information 收款銀行資料:
Beneficiary Bank Name:
收款銀行名稱
(This is the financial institution where the beneficiary maintains their account.)
___________________________________________________________
Bank Routing Transfer Number (ABA#) or SWIFT code:
收款銀行 ABA 號碼或 SWIFT 號碼
_______________________________________
收款銀行 SORT 號碼（如匯往加拿大或者英國則必須填寫此項）
_______________________________________
International Sort Code: (required if Canada or UK):
Beneficiary Bank, City, State, Zip, Country: (Required) 收款銀行地址，城市、州、 郵遞區號及國家 （必填）
___________________________________________________________________________________
3. Intermediary Bank Information 中介銀行信息（若適用）:
(This is the financial institution that the wire must pass
through before reaching the final beneficiary bank.) This section is OPTIONAL and not required.
Intermediary Bank Name:
中介銀行名稱
___________________________________________________________
Intermediary Bank ABA number or SWIFT code:
中介銀行 ABA 號碼或 SWIFT 號碼
____________________________________________
4. Customer Authorization 客户授权:
Account Holder Signature 帳戶持有人簽名:
Joint Account Holder Signature 共同持有人簽名(若適用):
____________________________Date 日期:_____________
________________________Date 日期:_____________
I agree to hold all parties acting on this request, including the introducing broker and Apex Clearing Corporation, and their respective agents and
employees (hereafter, collectively, “the parties”) harmless from any and all claims, demands, proceedings, suits, and actions and all liabilities, losses
and expenses including without limitation those asserted by me, associated with actions taken by the parties due to instructions received from me
in this request.
Notary Required for Third Party Wires 匯款發至第三方帳戶需要公證:
_________________________________________________
Notary Signature 公證人簽名
FOR INTERNAL USE ONLY 限第一理財內部使用
Signature Verified:
____________________________
Telephone Confirmation:
_______________________
Processed By:
_______________________
Processed Date:
_______________________
Registered Principal Approval: Name:______________
Compliance Officer Approval:
Name: ______________
IWRE
____________________________________________
Notary Seal 公證人蓋章
Approved By:
_______________________
_______________________
_______________________
_______________________
Signature: _________________
Date:__________
Signature: _________________
Date: __________
WFA_IWRE_ZHTW_1113