定期存款申請書

Time Deposit Application Form

致:日商瑞穗銀行股份有限公司臺北分行	臺中分行	高雄分行	國際金融業務分行	日期Date：

To : Mizuho Bank, Ltd.	Taipei Branch Taichung Branch Kaohsiung Branch	Offshore Banking Unit Taiwan

傳真指示扣帳(請勾選。僅限與 貴行簽訂「電話傳真交易授權書」者適用) Withdraw with Fax instruction (Please mark. Only for use by Applicants who have signed the “Letter of Authorization – Telephone and Fax Transaction” with the Bank)

有存單(With Certificate) 無存單(Without Certificate)

申請人名稱(Applicant Name)	申請人身分證/統一編號(Applicant ID / Unified No.)
申請明細(Application Details) 存款幣別與金額 Deposit Currency & Amount: 幣別CCY 金額Amount 存款期間Deposit Period: 期別Tenor： 年Year(s) 月Month(s)； 或or期間 Period：自 年 月 日 至 年 月 日 From (YYYY/MM/DD) to (YYYY/MM/DD) 年利率Annual Interest Rate: 以承作日當天之牌告利率The board rate at value day (固定Fixed 機動Floating)；或 or 其他others % P.A.年息 利息支付方式Interest Payment : 到期付息Pay at maturity；按月領息，存入申請人於 貴行存款帳戶 Pay monthly and credit to the account at the Bank as designated below ；其他others 資金來源(Source of Funds): 同意自申請人於 貴行之下列存款帳戶扣款，於下列申請人簽章處蓋上取款印鑑，視同授權扣帳(取款印鑑與定存印鑑不同時則需另開立取款憑條)；扣款帳號 Applicant agrees that the Bank may withdraw the funds from Applicant’s account with the Bank. Affixing the withdrawal seal which is identical to the one registered with the Bank at the signing/sealing place below shall be deemed proof of Applicant’s authorization for the withdrawals (Please provide a withdrawal slip if “Withdraw Seal” is different from “Time Deposit Seal”), Debit A/C No. 其他(請註明) Others (Please specify)
自動續存處理指示(Automatic Renewal Instruction) 本金及利息與原存款相同之期限自動續存，其利率以續存當日之利率為準。 Automatically renew the principal and accrued interest to another time deposit for the same period, at the rate for similar deposits as of the date of renewal; 本金以與原存款相同之期限自動續存，其利率以續存當日之利率為準，利息按月存入申請人於 貴行之存款帳戶。 (帳號： ) Automatically renew the principal to another time deposit for the same period, at the rate for similar deposits as of the date of renewal and credit the accrued interest thereon monthly to Applicant’s account with the Bank (A/C No. ) *定期存款自動續存以99次為限，申請人如擬終止自動續存之約定，應於存款到期至少二個銀行營業日前通知 貴行。 Automatic renewal is limited to 99 renewals. Should any termination of the automatic renewal be desired, prior notice given by Applicant must be served on the Bank at least two banking business days prior to the scheduled maturity date.
到期處理指示(Maturity Instruction) 有存單定存(With Certificate)：申請人於存單内註明到期處理指示並交付 貴行。 Maturity instruction will be indicated in the certificate and delivered to the Bank. 無存單定存(Without Certificate)： 本金及利息全部存入申請人於 貴行之存款帳戶 (帳號： ) Credit the entire proceeds to Applicant’s account with the Bank (A/C No. ) 申請人於「定期存款通知書暨到期指示書」内註明到期處理指示並交付 貴行。 Maturity instruction will be indicated in the “Time Deposit Advice & Maturity Instruction” and delivered to the Bank Seal is omitted when sending through Mizuho Global e-Banking 申請人簽章(存款約定章) APPLICANT AUTHORIZED SIGNATURE(S) /SEAL(S) (SEAL FOR DEPOSIT ACCOUNT) 其他(請註明) Others (Please specify)

本存款於此申請書所載到期日屆滿後支付。

The deposit is payable on the maturity date as specified in this Application.

本定期存款禁止轉讓。非經 貴行事先書面同意，不得供作質押。

No assignment/transfer of this time deposit shall be permitted. A pledge of this time deposit shall only be binding on the Bank if a prior written consent is obtained from the Bank.

如申請人須解約或變更到期處理指示時，須以 貴行規定之書面指示通知 貴行。

If Applicant wishes to cancel the time deposit or make changes to the maturity instruction, Applicant shall provide the Bank written instructions as requested by the Bank.

本存款應適用申請人與 貴行簽定之存款約定書及其嗣後公告修訂之各項内容。

This time deposit shall be governed by the General Agreement For Deposit Account executed between Applicant and the Bank as well as the contents thereof as may be amended from time-to-time.

主 管	經 辦	核 章

【FOR BANK USE ONLY】

定存編號 Time Deposit No.:

(G7097) Electronic Application 20180209

Note：使用此申請書時，本人/本公司同意不更動除填記欄位以外之申請書內容及文字，若更動該申請書內容或文字而造成 貴行損失時願負一切責任。