GoRemit Shinsei Overseas Remittance Service Application for Individuals

Transcription

1 GoRemit Shinsei Overseas Remittance Service Applicationfor Individuals NameAccount Holder Information Kana Kanji Last Name First Name Middle Name If applicable Home AddressContact Information Kanji Application date Date of Birth English Gender M F Nationality English Self employed TEL Mobile Occupation Company Employee Company Executive Government Employee ProfessionalDoctor, Lawyer etc. Faculty Member Agricultural Employee Freelance Contractor Part-time worker Student International Student Homemaker Technical Trainee Unemployed Other Please specify If you are self employed, please choose one of the following. Personal Use Business Use Web site Company Name If you are self employed, please fill in Business name Company Address If you are self employed please fill in Office address Tel Tpe of industry EnergyTrading company, Wholesale Trade, Retail Trade, RestaurantFinance, Securities, InsuranceReal Estate Transportation, CommunicationsHospitalityGovernment, EducationAgriculture/Forestry and Fishery, Mining ConstructionAutomotive, Transport equipmentelectric, Electronic equipmentfoods, Pharmaceutical, Cosmetics Other ManufacturingOthers Number of employees in company Position in company How did you learn about GoRemit? Shinsei Bank Web Site GoRemit Web Site Google Yahoo! Search Engine Shinsei Financial Center Introduced bynameother I hereby agree to all parts of the "GoRemit Terms and Conditions (for Individuals)", "Handling of Personal Information of Individual Customers" and "Representations and Covenants Renouncing Antisocial Forces" and apply for the GoRemit Shinsei Overseas Remittance Service. I declare that all information I have provided here is correct. Additionally, in case of any change in registered information such as name, address, occupation, etc., I will submit the required documents according to Shinsei Bank's procedures. I confirm that my name and address as provided above and the "Purpose of Use of Individual Numbers" as defined in "Handling of Personal Information of Individual Customers" are correct and submit my Individual Number to Shinsei Bank for the purpose of setting up an "identified account" in accordance with Article 2, Paragraph(6) of the "Act on Submission of Statement of Overseas Wire Transfers for Purpose of Securing Proper Domestic Taxation". I confirm that all information I have provided is correct. Should there be any change to my personal details (name, address, occupation, Individual Number, etc.) I will update my information by submitting the application form prescribed by the Bank. Before signing/sealing the form, please read and confirm the included "GoRemit Terms and Conditions for Individuals","Handling of Personal Information of Individual Customers" and "Representations and Covenants Renouncing Antisocial Forces" Your application will be subject to screening based on our rules. Please be aware that in some circumstances we may not be able to accept your application.

2 Please fill in all sections marked with bold lines. CurrencyPlease select one currency CurrencyUSD GBP CAD AUD NZD EUR CHF HKD SGD SEK INR JPY Beneficiary Bank Information Beneficiary Bank SWIFTBIC 8 or 11 Digits Branch Name Beneficiary Bank Address if unknown, city name only is acceptable Beneficiary Account Information For remittances to the below countries, please confirm the relevant code Please see the included sheet for more information regarding bank codes. USAABA/Routing Number UKSort Code AustraliaBSB New ZealandBSB CanadaTransit Number INDIAIFSC Beneficiary Bank Account Number IBANRequirement depends on beneficiary bank country see attached sheet for more information Beneficiary Account Name Account holder name Beneficiary Account Address Please ensure the city name is provided. For remittances to Canada the full address is required Beneficiary's relationship to yourself Beneficiary's current country of residence Message/Special instructions Please mark with a circle to Beneficiary Bank to Beneficiary Account holder up to 140 characters Intermediary Bank Please designate if necessary Source of funds Note Salary Savings Pension Business Proceeds Please fill in "Message/Special instructions" if the note is to beneficiary bank/account Scholarship Others Please specify Purpose of remittance Import, Purchase of Goods 1 Intermediary Trade 1 Please fill in 1 below Expense for Study Abroad 2 School Expensesexcl. Study Abroad 2 Travel Expenses 2 Please fill in 2 below Investment Details Savings Gift / Donation To Individual To Corporate Loan Payment Type of Loan Medical Expense Living Expense for Relatives / Friends RelationshipOther Please Provide specific details If selected purpose of remittance marked with, please provide details in the brackets. 1 If purpose of remittance is payment for Import, Purchase of Goods or Intermediary Trade, please fill in the following boxes. Kind of goods Country of origin Place of shipment If China, South Korea or Russia, provide city/port name Destination of goods 2 If purpose of remittance is Expense for Study Abroad, School Expensesexcl. Study Abroad, and Travel Expenses, please fill in the following boxes. Date of departure Length of stay Relationship to person traveling

3 Application of Remittance Volume Limit for Individuals To Shinsei Bank, Ltd. In accordance with the Foreign Exchange and Foreign Trade Act, we will carry out confirmation on overseas remittances that exceed setremittance volume limits before executing the remittance transaction to ensure that transactions are not related to restricted countries, i.e. North Korea and Iran, etc. We will not be able to accept overseas remittances without completion of this confirmation process. Please fill in and apply for your remittance volume limit based on your expected remittance amounts. 1.Please fill in and apply for your remittance volume limit based on your expected remittance amounts. Upon considering the requested volumes, your remittance volume limits will be set by Shinsei Bank within the range applied for. Please check the "Notification of Remittance Volume Limit" issued by the Bank to confirm your remittance volume limits. The remittance volume limits set by the Bank may lower than the volume you requested. If no amounts are provided or this application is not attached, we will set the remittance volume limits based on the Bank's prescribed criteria. Please do not write the application form with erasable pen. Name Last Name First Name Please fill in all sections per remittance/monthly/annual total.aligning to the right. Remittance volume limit per remittanceyen Please fill in your expected maximum remittance amount per single remittance. This limit will apply to all beneficiaries. If you have multiple beneficiaries registered, please provide the maximum amount you expect to send to any given beneficiary in a single remittance. JPY Monthly total remittance volume limityen Please fill in your expected maximum total accumulated remittance amount per month. Customers with multiple beneficiaries should fill in the expected total monthly accumulated amount of all beneficiaries. This not a monthly average, please provide the maximum expected volume for any given month. Annual total remittance volume limityen Please fill in your expected maximum total accumulated remittance amount per year (1st Jan - 31st Dec). Customers with multiple beneficiaries should fill in the expected total annual accumulated amount of all beneficiaries. This does not have to be 12 times the monthly remittance volume. 2.If your requested annual total remittance volume limit exceeds JPY 3.6million, please submit the following documents from both Category 1 and Category 2. If the annual total remittance volume limit exceeds JPY 3.6 million, the following documents are required in order to validate the details of the submitted form. Please enclose at least one applicable item each from both Category 1 and Category 2. If you have multiple beneficiaries, a document from Category 2 is required for each beneficiary. Even if the annual total remittance volume limit does not exceed JPY 3.6 million, we may ask you to submit the below documents should we deem it necessary. We may also ask for additional documents not included below if we deem it necessary. Even if the below documents are submitted, the remittance volume limits set by the Bank may be less than the amount you requested. Category 1 A Copy of documentation to validate the source of funds being remitted Your name must be shown. Passbook or bank statement showing your balance which is the same amount or more of the annual total remittance volume within the last 3 months Passbook or bank statement that includes record of deposits/withdrawals for the last 3 months Tax return from the previous year Paycheck statement from within the past 3 months Employment contract showing your salary amount issued within the last 3 months OtherPlease contact us, we will provide further guidance depending on the type of income Category 2 A copy of documentation to validate the purpose of remittance Savings Passbook or bank statement of beneficiary account.* Loan Payment Investment Real estate purchase 3.Precautionary Statement Copy of loan contract or passbook/bank statement showing the loan balance or withdrawal from loan company.* Copy of documentation that details investment product, pricing, etc. Copy of real estate contract/estimate etc. Living Expense for Relatives/Friends Passbook or bank statement of beneficiary which shows deposit and withdrawal history within the last one month.* Expense for Study Abroad Travel Expenses Import, Purchase of Goods Medical Expense Other Copy of tuition bill/estimate, etc. issued by educational institution Itinerary issued by travel agency/airlines etc. Invoice/Receipt etc. Invoice/Receipt etc. Please contact us. We will provide further guidance depending on the purpose. Account name must be shown. In the event of remittance funds exceeding predetermined limits, a member of our staff will call after confirming receipt of funds to confirm the remittance does not fall under transactions subject to the "regulations on trade-related payment" concerning North Korea, the "regulations on the purpose of use of funds" related to nuclear development, etc., and the "regulations on the purpose of the use funds" related to nuclear development, etc. and large conventional weapons in Iran. We will not be able to accept overseas remittances without completion of this confirmation process. Shinsei Bank is not held responsible for any loss or damages caused as a result of, for instance, a failure to execute a remittance, delay in remittance or incurred exchange losses because the confirmation prescribed above is not obtained.

4 Application date Please provide the date you fill in the form. Name Please leave the Kanji and Kana boxes blank if you do not have a Kanji or Kana reading of your name. Please ensure your first, last, middle name on the account application form must be the same as on your certificate or card. Date of birth Please provide your date of birth. Nationality This should be the country of nationality as recorded in your passport. Sample of completed Application form 1 Please read and follow the instructions carefully to complete your application. Applicants must be 20 years of age or older and currently reside in Japan. If you are classified as a "foreign PEP"Politically Exposed Person " An important public official of a foreign country," "A person formerly in category," or " A family member of a person in category or ", please contact GoRemit customer service and follow the guidance on how to apply. For details, please check the "Foreign PEPs" page on GoRemit Website Please fill in the highlighted boxes. Please do not write the application form with erasable pen. Please note that we do not return account application forms or identification documents that have been submitted. Home address The address supplied must be your current address and must match the address shown on your ID. If the address on your ID is not current, please update it before sending in your application form. Your application cannot be accepted if the address provided and the address shown on your ID do not match. Contact Information Please provide your contact Information. Occupation Please select from here. If "Other", please specify Self employed If you are self employed, please advise whetheryour remittances will be for personal or business reasons. When remitting for business purposes,you may be asked to provide an invoice for your transactions. If you are a registered company, please apply for our service as a Corporate User. Company name and Company address Please provide company name, address and telephone number. Type of Industry Please select from here. Number of employees in company Please select from here. Position in company Please select from here. How did you learn about GoRemit? Please tell us how you learned about the GoRemit Shinsei Overseas Remittance Service. Signature or Seal Please sign or stamp. We cannot accept multiple, unclear or overlapping seals or signatures. How to make a correction If you make a mistake when filling in the form, please follow the instructions below. Correction tape is not acceptable. When using a signature as identification Signature Cross out the mistake using two parallel lines. Provide your signature in the nearest available space to the correction. When using a personal seal hankoas identification Cross out the mistake using two parallel lines. Stamp over the parallel lines.

5 Sample of completed Application form 2 Please fill in the boxes. Currency Please select the currency of transfer. The currency should be the same local currency of the country in which bank branch is situated if we offer that currency. USD and EURO can be remitted to any country. Remittances in JPY are limited to specific banks. If you wish to remit in JPY, please call us to confirm. Beneficiary Bank / Branch name Please input the full name of the bank where the beneficiary s account is held. Beneficiary Bank Address Please input the address of the bank where the beneficiary s account is held. if unknown, city name only is acceptable SWIFTBIC For details, please refer to the How to fill in the IBAN / Bank code / SWIFT code columns. Bank code This code is different from the bank account number. For details, please refer to the How to fill in the IBAN / Bank code / SWIFT code columns. Beneficiary Bank Account Number This is the beneficiary s recipient saccount number. IBAN For details, please refer to the How to fill in the IBAN / Bank code / SWIFT code columns. Beneficiary Account Name This is the account holder s name recipient's account name Beneficiary Account Address This is the beneficiary s recipient'saddress as registered with their bank. Please ensure the city name is provided. Beneficiary s relationship to yourself If you are sending funds to your own account, please type myself in this box. If the beneficiary account is not in your name, please provide the nature of your relationship to the intended beneficiary. e.g. my brother, the store where I bought a book or stock company which I use" Beneficiary s current country of residence This is the country in which the beneficiary currently lives and is not necessarily the same as their nationality. If you are sending to your own overseas account that is in your own name simply choose Japan, because you currently reside in Japan. Message / Special instructions If you wish to include a message to the beneficiary, please fill in this box. Please mark with a circle to Beneficiary Bank to Beneficiary Account holder up to 140 characters Intermediary Bank If the beneficiary bank has specified an intermediary bank, please provide the intermediary bank name, branch etc, as well as the account number that the beneficiary bank holds with the intermediary bank if applicable. Source of funds Please select from here If "Other", please specify. Purpose of remittance Please input the purpose of remittance. If the purpose of remittance is payment for purchasing or importing goods or intermediary trade, please complete section 1. If the purpose is School Expenses, Expense for Study Abroad or Travel Expenses, please complete section 2. For "Loan Payment", please provide the type of loan eg. Student Loan For "Family Support", please advise which family memberswill be receiving support eg. Daughter GoRemit is available only to current residents in Japan. If you will be going overseas, please complete all remittances before leaving Japan. Place of shipment Please provide the country or the name of place where the goods will be shipped from. If the place of shipment is China, South Korea or Russia, please provide city/port name. Destination of goods Please provide the destination of the goods. e.g. if the goods are being imported to Japan, please write Japan.

6 Sample of completed Application form 3 Name Please fill in your last and first name as provided on the application form. Remittance volume limit per remittance Yen Please fill in your expected maximum remittance amount per single remittance. Monthly total remittance volume limit Yen Please fill in your expected maximum total accumulated remittance amount per month. Customers with multiple beneficiaries should fill in the expected total monthly accumulated amount of all beneficiaries. This not a monthly average, please provide the maximum expected volume for any given month. Annual total remittance volume limit Yen Please fill in your expected maximum total accumulated remittance amount per year 1st Jan - 31st Dec. Customers with multiple beneficiaries should fill in the expected total annual accumulated amount of all beneficiaries. This does not have to be 12 times the monthly remittance volume.

7 How to fill in the IBAN / Bank code / SWIFT code columns Certain bank codes are required when sending funds to the following countries. If you are unsure of the correct bank branch code please contact the relevant bank directly or have the beneficiary confirm for you. The format of this code is different from the bank account number. Providing the Bank code helps ensure quick and safe credit of funds to the beneficiary bank. Failure to provide correct information to GoRemit may result in a delay in delivery, or non-delivery of funds into the intended beneficiary s account. Country in which bank branch is situated Currency IBAN Bank / Branch code SWIFT Number of digit United States / USD ABA number Fed wire / Routing number 9 Great Britain / GBP Sort code 6 Canada / CAD Transit number + Institution number or / Routing number Transit number + Institution number : 5+3 Routing number : 9 Australia / AUD BSB number 6 New Zealand / NZD BSB number 6 India / Europe / Sweden / Switzerland / Mexico / UAE / Croatia / Jordan / Kuwait / Pakistan / Qatar / Guatemala / INR EUR SEK CHF Regardless of the Currency IFSC IFSC : 11 SWIFT : 8 or / 11 IBAN : Max34 SWIFT : 8 or / 11 IBAN : Max34 SWIFT : 8 or / 11 IBAN : Max34 SWIFT : 8 or / Please fill CLABE in the account number field. IBAN : Max34 SWIFT : 8 or / 11 Regarding remittances to China China In order for individuals in China to work in the trading business, they must be registered in accordance with their local regulations. If their bank account type and the purpose of the remittance do not match, remittances may be delayed or rejected altogether. Please confirm in advance with the beneficiary that they are able to receive remittances for the purpose of trade.

8 Application Check List Before submitting your application, please ensure you have completed the following: Have you enclosed the following documents? 1GoRemit Shinsei Overseas Remittance Service Application for Individuals 2Application of Remittance Volume Limit for Individuals Additional documents to validate your fund source and remittance purpose will be required depending on your request remittance volume limit. 3Documents Required for Applicaion Individual number documents and Identification document Have you checked that address provided on the application form and the address shown on your ID copies match? GoRemit is available only to customers currently residing in Japan. Customers who have left Japan are not eligible to use this service. Is the form signed/sealed and dated? If you have made a correction, have you included your signature or seal? Corrections must be made with the same signature or seal used on the application form. Correction fluid is not acceptable. Corrections to your name cannot be accepted. Please complete a new form. Have you enclosed any one of the following ID documents which contains your Individual Number? 1A copy of Individual Number NotificationIf your address is shown on the reverse side, please provide this side as well 2Official transcript of Resident Recordjuminhyo no utsushior Certificate of Registered Items on Resident RecordIndividual Number must be shown. This document must be issued within the past 6 months. 3A copy of Individual Number Card Plastic card with a photo Please copy both sides. Please black out the declaration of organ donation. Have you check the included "Documents Required for Application" sheet and enclose the necessary documents such as Residence Card? Please take care as your registration cannot be completed without submittal of the appropriate documents. Is the copy of your ID clear and legible? Please ensure photocopies are provided on vertical A4 paper. Do not cut to size. If your requested annual total remittance volume limit exceeds JPY 3.6million, have you enclosed the following documents from both Category 1 and Category 2. If the annual total remittance volume limit exceeds JPY 3.6 million, the following documents are required in order to validate the details of the submitted form. Please enclose at least one applicable item each from both Category 1 and Category 2. If you have multiple beneficiaries, a document from Category 2 is required for each beneficiary. Even if the annual total remittance volume limit does not exceed JPY 3.6 million, we may ask you to submit the below documents should we deem it necessary. We may also ask for additional documents not included below if we deem it necessary. Even if the below documents are submitted, the remittance volume limits set by the Bank may be less than the amount you requested. Category 1 A Copy of documentation to validate the source of funds being remitted Your name must be shown. Passbook or bank statement showing your balance which is the same amount or more of the annual total remittance volume within the last 3 months Passbook or bank statement that includes record of deposits/withdrawals for the last 3 months Tax return from the previous year Paycheck statement from within the past 3 months Employment contract showing your salary amount issued within the last 3 months OtherPlease contact us, we will provide further guidance depending on the type of income Category 2 A copy of documentation to validate the purpose of remittance Savings Passbook or bank statement of beneficiary account.* Loan Payment Investment Real estate purchase Copy of loan contract or passbook/bank statement showing the loan balance or withdrawal from loan company.* Copy of documentation that details investment product, pricing, etc. Copy of real estate contract/estimate etc. Living Expense for Relatives/Friends Passbook or bank statement of beneficiary which shows deposit and withdrawal history within the last one month.* Expense for Study Abroad Travel Expenses Import, Purchase of Goods Medical Expense Other Copy of tuition bill/estimate, etc. issued by educational institution Itinerary issued by travel agency/airlines etc. Invoice/Receipt etc. Invoice/Receipt etc. Please contact us. We will provide further guidance depending on the purpose. Account name must be shown.

9 Documents Required for Applicationfor foreign nationals In addition to Identification documents, Individual Number documents are required. Applicants must be 20 years of age or older and currently reside in Japan. The address the account application form must be the same as on your certificate or card. The copy of your Document Required for Application must be clear and legible.please provide photocopies on a vertical A4 sheet of paper. Please do not cut to size. Corrections to your name cannot be accepted. Please complete a new form. B Individual Number documents 1 Identification documentswith a photo 1 total 2 items Individual Number documents Documents Official transcript of Resident Record juminhyo no utsushi or Certificate of Registered Items on Resident Record Individual Number NotificationCopy Individual Number CardCopy plastic card with a photo Note Please provide all pages including those showing the date of issue and issuer's seal. Please provide an original copy issued within the past 6 months.name, Address, Date of Birth, Gender, Period of Stay and Individual Number must be shown. If your address is shown on the reverse side, please provide this side as well. Please copy both sides. The front side name, address, date of birth, gender must be shownand reverse side individual Number must be shown. Please ensure the document is not expired. If there is a correction change address etc, please update information at your local city/ward office. B Identification documentswith a photo copy Documents Residence CardCopy or Special Permanent Resident CertificateCopy Japanese drivers licensecopy or driving career certificatecopy Note Please ensure the number on the upper right of the front side is clear. Please copy both sides. Please do not black out your nationality. Please ensure the seal on the lower right of the front side is clear. If new information is shown on the reverse side, please ensure the correction seal is clear. Issued date must be more than 6 months ago. We may contact you to confirm your residency. Samples of Required Documents Documents submitted must be within their expiry date or currently valid. Please black out place of birth or sensitive information. Please do not black out any other details. If new details are shown on the reverse side of the document submitted, please ensure that the copy taken is clear and legible. Residence Card copy Japanese drivers license copy Official transcript of Resident Record juminhyo no utsushi Please ensure card number is clear and not cut-off by the photocopier. Do not black out address. If the certificate consists of multiple pages, please provide all pages. Please ensure that issuer s seal is clearly visible. also required when new information is added to the reverse side

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