Bank Transfer Request Form

ALL CLEAR/Kanazawa
University/(DD/MM/YYYY)

Working dept., etc. (Other than students)
Graduate Schools/Schools (Students)
Name(Katakana)Name (Alphabet)*Please handwrite the form without fail.

Please transfer payments to my deposit account of financial institution specified below.
1. Name of account holder(Katakana)

2. Name of account holder (Alphabet)

3. Type of account
Saving account /4. Account number (Please left-align the number)

Checking account

5. Name of financial institution for transfer
Name of financial institution
1.Hokuriku Bank, Ltd.
4.Sumitomo Mitsui Banking
Corporation
2.Hokkoku Bank, Ltd.
5.Kanazawa Shinkin Bank
3.Bank of Mitsubishi UFJ,Ltd.
6.Other Bank code
Bank name(Name of office/branch
Head office
BranchSub-branch)＊Fill in the branch code

(Branch code)

6. DOB (in Western calendar)

YYMMDD

7. Current address (for use in the certificate of income and withholding tax) *As for the University Administrative
staff, entry is unnecessary.
〒

8. Telephone number()＊振込以外の場合は該当に�

事務担当係記入欄(Please leave the fields blank.)

・登録の種類
１新規２修正・債主区分＊同一名義の債主が既に存在する場合

３削除＊常勤職員の場合は職員コードを記入。その他でも職員コード(非常勤職員等)があるときは記入

１常勤職員
・修正・削除理由
その他特記事項☐現金☐外国送金☐᪤Ꮡྠ୍ྡ⩏࠶ࡾ＊該当の種類に○をつける。(旅費以外の場合も極力記入)
旅費区分

役員

学内
教授相当

学外
その他職員

２その他
＊修正の場合は債主コードを記載

部・担当係担当者(内線番号：)【Protection of Personal Information】
The personal information you provide will be used only for payment by Kanazawa University and will
not be used for any other purposes.

学生䠘グධ౛䠚

Bank Transfer Request Form‫ س‬/ ‫ س‬/ ‫( سسس‬DD/MM/YYYY)

Kanazawa
UniversityWorking dept., etc. (Other than students) ‫سسسسسس‬Graduate Schools/Schools (Students)

ᢲ༳୙せName(Katakana) ॺ঒‫ؙ‬ॡঝ‫ش‬६Name (Alphabet) 䠆ᚲ䛪ᮏே䛜⮬⨫䛧䛶ୗ䛥䛔䚹㻌*Please handwrite the form without fail.

Please transfer payments to my deposit account of financial institution specified below.
1. Name of account holder(Katakana)
ॺॡ

঒

ঝ

‫ش‬

६

5

8

2. Name of account holder (Alphabet)
72

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 Type of account
Saving account /. Account number (Please left-align the number)

Checking account‫س‬‫س‬‫س‬‫س‬‫س‬‫س‬‫س‬

 1DPHRIILQDQFLDOLQVWLWXWLRQIRUWUDQVIHU 㖟⾜ࢥ࣮ࢻཬࡧᨭᗑࢥ࣮ࢻࡣ㏻ᖒぢ㛤ࡁ࡟グ㍕ࡉࢀ࡚࠸ࡲࡍࠋName of office/branch
Name of financial institution
Hokuriku%DQN/WG
.Sumitomo Mitsui Banking
Head officeCorporationBranch‫سسسس‬Hokkoku Bank, Ltd.
Kanazawa Shinkin Bank
Sub-branchBank of Mitsubishi UFJ,Ltd.
Other%DQNFRGH%UDQFKFRGH%DQNQDPH

(‫سسس‬%$1.

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7. Current address (for use in the certificate of income and withholding tax) *As for the University Administrative
staff, entry is unnecessary.
ࠛ ‫س س س‬‫س‬‫س‬‫س‬‫س‬‫سسسسسسسسسسسسسسسسسسسسس‬8. Telephone number( ‫) سسس‬‫سسس‬䠆᣺㎸௨እ䛾ሙྜ䛿ヱᙜ䛻ᤵᤷᤶ஦ົᢸᙜಀグධḍ(3OHDVHOHDYHWKHILHOGVEODQN)
࣭Ⓩ㘓ࡢ✀㢮㸯᪂つ 㸰ಟṇ࣭മ୺༊ศ- ‫سسسس‬䠆ྠ୍ྡ⩏䛾മ୺䛜᪤䛻Ꮡᅾ䛩䜛ሙྜᤵᤷᤶ㸱๐㝖㸨ᖖ໅⫋ဨࡢሙྜࡣ⫋ဨࢥ࣮ࢻࢆグධࠋࡑࡢ௚࡛ࡶ⫋ဨࢥ࣮ࢻ 㠀ᖖ໅⫋ဨ➼ ࡀ࠶ࡿ࡜ࡁࡣグධ㸯ᖖ໅⫋ဨ・修正・削除理由
その他特記事項‫⌧܆‬㔠‫܆‬እᅜ㏦㔠‫܆‬᪤Ꮡྠ୍ྡ⩏࠶ࡾ䠆ヱᙜ䛾✀㢮䛻䕿䜢䛴䛡䜛䚹㻔᪑㈝௨እ䛾ሙྜ䜒ᴟຊグධ㻕㻌᪑㈝༊ศᏛෆ  Ꮫእᙺဨࠉᩍᤵ┦ᙜࠉࡑࡢ௚⫋ဨࠉᏛ⏕㸰ࡑࡢ௚㸨ಟṇࡢሙྜࡣമ୺ࢥ࣮ࢻࢆグ㍕ 㒊࣭ᢸᙜಀᢸᙜ⪅ෆ⥺␒ྕ㸸
࠙Protection of Personal Informationࠚ
The personal information you provide will be used RQO\for payment by Kanazawa University and will
not be used for any other purposeV.