附件4_银行信息表120406

请用英文填写机构信息Organization Information/Name ofOrganization:机构名称（必须与项目申请单位名称完全一致）Mailing address:通信地址Legal Representative:法人或法人授权代表姓名Title:法人职务Tel:Fax:Email:电话传真邮箱地址:/付款信息:Bank WireInformation银行账户名称Organization bankaccount name:银行账号Organization bankaccount#:Bank nameof organization:开户行名称Bank SWIFTcode:银行交易代码I aman authorizedrepresentative ofthe organizationlisted aboveandconfirm thecontact andbanking informationrepresented hereis accurateandremains unchanged.IhavealsoverifiedthatthisaccountcanreceiveUSDdonationsundertheregulationsissuedbytheStateAdministrationofForeignExchange.本人为上述机构授权负责人，确认上述机构信息及银行信息准确无误，同时确认上述账户符合国家外汇管理局有关规定可以接受美元赠款法人或法人授权代表签字Grantee authorizedsignature日期Date/姓名（拼音、打印或工整书写）/及职务Print Name/Title。