扣 帳 授 權 書

Letter of Authorization of Debit for Payment of Charges

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

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

(Referred to as “the Bank”)

立授權書人 茲授權 貴行自立授權書人於 貴行開立之支票/活期存款第 號帳戶之存款中扣除下列之本金、利息及費用。

I (we) hereby authorize(s) the Bank to deduct principals, interests, and / or service charges as listed below for my (our) account from my (our) Savings / Checking account (Account No.: ).

1.	承兌匯票之本金與承兌費。

Bank Acceptance.

2.	商業本票之本金與保證費。

Commercial Paper Guarantee.

3.	立約人依合約應給付或償還 貴行各種幣別貸款之本金與利息。

Repayment of loans.

4.	開立進口信用狀或進口託收單據或進口記帳方式付款之各項費用。

L/C Opening.

5.	押匯或託收之各項費用。

Negotiation.

6.	國內外匯兌之匯款及費用。

Remittance.

7.	其他各項費用

Other Fees.

立授權書人同意於同日期如有數筆款項應向 貴行繳付，而上開帳戶內之存款餘額僅足撥付其中部份款項時， 貴行得自行決定撥付之款項。倘上開帳戶內之存款餘額，不敷支付任何一筆立授權書人對 貴行之應繳款項時， 貴行即不予撥付轉帳，逕依 貴行有關催收之規定辦理，絕無異議。

In case that the Undersigned has to make more than one payment to the Bank at the same day and the balance in the account is sufficient to cover only part of the payables, the Undersigned agrees that the Bank may at its discretion apply the deposit in the account towards any payables chosen by it. In the event that the balance is not sufficient to cover any payable, the Bank shall collect the same pursuant to its collection rules instead of debiting the Undersigned's account rules.

立授權書人同意賠償 貴行因依本授權書辦理事項所生之任何損失及費用。

The Undersigned agrees to indemnify the Bank against all losses and expenses of any nature whatsoever which may be incurred or sustained by the Bank in connection with this Letter of Authorization.

立授權書人並同意，一經 貴行要求，立授權書人立即開立並支付應給付金額的支票或取款條予 貴行。

The Undersigned further agrees, upon the Bank's demand, immediately to issue and deliver to the Bank a check or a withdrawal slip to cover the amount debited, if necessary.

立授權書人:

Authorization: _____________________________________

立授權書人以存款印鑑卡上所留存之銀行往來印鑑作為扣帳授權章。

The specimen seal(s) on the Letter of Authorization of Debit for Payment of Charges shall be the same as the specimen seal(s) given on the Signature Card.

日期:

Date:

主管	經辦	核章