工商银行非本人交易附加说明

附表2：Attachment 2

非非非本本本人人人交交交易易易附附附加加加说说说明

明明 S S S u u u p p p p p p l l l e e e m m m e e e n n n t t t a a a r r r y y y S S S t t t a a a t t t e e e m m m e e e n n n t t t o o o n n n N N N o o o n n n ---c c c a a a r r r d d d h h h o o o l l l d d d e e e r r r T T T r r r a a a n n n s s s a a a c c c t t t i i i o o o n n n s s s

中国工商银行：

ICBC,

本人所持卡号 卡片有效期 ，现申明在 （日期） （国家或地区） (商户名称)交易总额为 的交易非本人交易，即交易非本人所

为，本人拒绝支付上述款项，请予以调查处理。

My card number is ____________ and the card is valid until_______. I hereby state that the transaction

dated on ________ in ________ (country or region) with ________ (name of merchant) totaling ________

(volume) is not made by myself. It is a non-cardholder transaction. I hereby refuse to pay for the abovementioned

transaction. Please investigate and handle it.

交易发生时本人身处的国家（地区）为 ，城市为 ，未曾参与上述交易，

对此本人愿意提供证据予以证明。

When the transaction was made, I was in ______ (city) of ______ (country or region) and was not involved

in the abovementioned transaction. I am willing to provide evidence to prove it.

对具体情况的说明：

Detailed explanation:

本人陈述：上述情况属实，本人愿意承担由此产生的一切法律后果。

Personal statement: the above information is true and I am willing to take any legal consequences incurred.

本人签名：

Sign here:_________

年 月 日

Date: ____________