PDF《签证退款申请书/Request for Visa Refund》

签证退款申请书/Request for Visa Refund 签证申请人姓名/Visa Applicant's name: 生日/Date of Birth: 退款原因/Reason for refund: ATM/网路电子银行 ATM/Internet bank not accepted.

已持有汇款单但未递交申请件/Deposit made but no application submitted. 超额付款/Overpayment 免付费/fee exempted 永久居民权利金/Right of Permanent Residence Fee 其他/other 退款金额/Refund Amount : NT$ 支票受款人名称 (请用正楷书写)/Beneficiary Name on Cheque (Print Only): 请勾选支票领取方式/ Please select the way you'd like to pick up the cheque : A. 亲自领取/ 本人亲领支票时,请出示身份证,方可领取支票. In person/ Please present your ID card at the time of collection. B. 本人授权 代为领取签证退款支票. I authorize to collect the cheque on my behalf. 代领人身份证或外侨居留证/ ID or ARC No. : 代领人电话/Tel : 如果支票受款人为个人,代领人需出示身份证,方可领取支票. If the payee is an individual, the authorized person must present an ID card at the time of collection. 如果支票受款人为旅行社,请出示代领人身份证暨公司章,方可领取支票. If the payee is a travel agency, the authorized person must present an ID card and the company chop at the time of collection. C. 请求将支票以挂号邮件出/ 邮件地址应提供两种文字:中文和英文 Send cheque by registered mail/ Mailing Address should be provided in Both English and Chinese characters: 亲自/授权领取支票者,请於收到电话通知后,持上述证件,迳赴加拿大驻台北贸易办事处领. 地址:11047 台北市信义区松智路

1 号6楼(华新丽华大楼)

电话:(02) 8723-3000 服务时间:星期一至星期四 09:00 C 12:00 &13:00 C 16:30 / 星期五

09 :00 C

12 :00 Upon receiving the notice by phone, please bring appropriate ID as stated above to the Canadian Trade Office in Taipei. Address: 6F, No. 1, Song Zhi Rd., XinYi District, Taipei 11047, Taiwan (CitiBank building) Telephone: (02) 8723-3000 Office Hour: 09:00 -12:00 and 13:00 C 16:30, Monday to Thursday/ 09:00 C 12:00 Friday 递交此表格时,请确认附上银行汇款原始收/Enclosed the ORIGINAL bank remittance receipt 连络电话/Tel : 连络人姓名/ Contact name: 签证申请人签名/Visa Applicant's signature : Official use only Received date: File No.: X-REF: Certified pursuant to Section

34 of the Financial Administration Act Signature Date