境外旅客购物离境退税申请单

附件3境外旅客购物离境退税申请单REFUND APPLICATIONFORM FOROVERSEAS VISITORS商店名称（章）Name ofRetailer Stamp开单日期年月日商店代码Code ofRetailerDate ofApplication Y.M.D.申请单编号File NO.姓名证件类型证件号码Full Name of ApplicantPassport TypePassport Number旅客签名证件签发国/地区入境时间Applicant,sPassport Issuedby Country/Region Date of Entryinto ChinaSignature商品明细Items forRefund购物发票号发票开具日价税合计申请退税额海关确认退税物商品名称退税率序号码Invoi ce期Dateof商品类别数量计量单位单价Unit金额Amount税额Price Amountof品数量Approved备注NameofRefundNumber numberInvoice CategoryQuanti tyUnit PricePaid Taxincluding RefundQuantity RemarksGoodsRateTax Applie12345678910合计Total海关确认意见Customs Approval经办人Official签章Stamp日期年月日Date Y.M.D.以下项目由旅客在申请退税申请时填写

1、退税方式Means ofRefund旅客退税申请现金Cash□转账Bank Transfer□开户行Bank Name银行账号Account No.Overseas Visitors

2、电话Tel旅客签名Applicant,s SignatureApplication日期年月日Date Y.M.D.。