PDF《直接付款授权》

5 working days prior to the date on which such cancellation/variation is to take effect. 本人/我们之银行及分行之名称 My/Our Bank Name and Branch 星展银行(香港)有限公司 DBS Bank (Hong Kong) Limited 银行编号 Bank No. 分行编号 Branch No. 本人/我们之账户号码 My/Our Account No.

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6 账户持有人之英文名称 Name of Account Holder(s) (in English) 本人/ 我们在结单/ 存摺上所纪录之地址 My/Our Address as recorded on Statement/Passbook 请确认你的指示已清楚,准确及完整地填妥於本表格内才签署作实. Please confirm that your instructions have been clearly, accurately and completely set out in this form before signing it. 填写日期 Completion Date 账户持有人签署 附注

4 Signature(s) of Account Holder(s) Note

4 银行专用 For Bank Use Only Attended By (Signature, Name & Date) Initial the action(s) taken: (Mark name & date if different from the attending staff.) Approved By (Signature with No., Name & Date) * 请删去不适用者 Please Delete whichever inapplicable 附注 1. 在债务人之参考栏内,请将贵户与受款一方之关系,略予说明(如 客户号码等),你或需要向收款人查询详情. 2. 如台端付款之数额每次可能不相同,则请将最高者定为每次付款 之最高限额. 3. 本直接付款授权指示将於「到期日」一栏中所填写之日期自动撤 销.如贵户意欲本直接付款授权指示无限期有效(或直至贵户予以 撤销为止),则请将该栏划去. 4. 请保证贵户在此授权书内之签名,与银行账户所签者完全相同. NOTES: 1. In the box marked 'Debtor's Reference', enter the identifying reference between yourself and the party to be credited, e.g. Account Number, you may refer to the beneficiary for detail. 2. If the amount of your payments is likely to vary each time, set the limit for each payment at the maximum amount you would expect to pay at any one time. 3. This Direct Debit Authorization will be cancelled automatically on the date included in the box marked 'Expiry Date'. If you wish the Direct Debit Authorization to have effect indefinitely (or until cancelled by you) please cross out the box. 4. Please ensure that you sign the form in the usual way that you would sign on your Bank Account. ( 文义如有歧异,应以英文本为准 The English version shall prevail if there is a discrepancy between the English & Chinese versions ) S.V.