額度支用申請書

APPLICATION FOR UTILIZATION OF CREDIT LINE

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：

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

(the “Bank”)

茲向 貴行申請支用授信金額、種類及條件列述如下：	編號：

We hereby apply to the Bank for credit in the amount, and type, and on the terms and conditions set forth below:	No.

申請人APPLICANT	幣別CURRENCY NTD USD JPY	金額AMOUNT
撥款日VALUE DATE 年 月 日	到期日MATURITY DATE 年 月 日	利率： 固定 浮動 INTEREST RATE: Fixed Floating
授信種類 TYPE OF CREDIT
新臺幣貸款NTD Loan 外幣貸款Foreign Currency Loan 新臺幣商業本票保證NTD Commercial Paper Guarantee 外幣商業本票保證Foreign Currency Commercial Paper Guarantee	匯票承兌Bank Acceptance ( i) 匯票共 張 (ii) 交易憑證（正本及影本各乙份，正本驗畢退還）Certificate of transaction (original and photocopy; the original will be returned after verification)	票據貼現Bills Discount 出口融資貸款Export Refinancing 進口融資貸款Import Refinancing 進口No. Import No. 融資日數 Refinancing Days 其他（請註明）Others (Please specify)
付款方式DISPOSITION OF PROCEEDS 存入 銀行 分行 第 號帳戶 Credit our account with Bank, Branch, Account No. 償還本人／本公司向貴行申請之貸款 Repay our previous loan(s) with the Bank 其他（請註明）Others (Please specify)
利息/保證費支付方式 PAYMENT OF INTERESTS/ GUARANTEE FEE 申請人授權 貴行就申請人於 貴行活存或 支存 帳號 之存款帳戶轉帳代繳；或以申請人於扣帳授權書所載帳號之存款扣抵之；或其他 (請載明其他支付方式)。We hereby authorize the Bank to make the payment by withdrawing from our demand deposits or checking deposits (Account No. ______________) with the Bank, or to deduct the payment amount from our bank account designated in the Letter of Authorization of Debit for Payment of Charges, or others _____________ (Please specify). 申請人未為勾選時，申請人授權 貴行以申請人於扣帳授權書所載帳號之存款扣抵之。If we do not check any of the above boxes, we hereby authorize the Bank to deduct the payment amount from our bank account designated in the Letter of Authorization of Debit for Payment of Charges.
申請人茲無條件許諾並同意悉數償還 貴行依據本申請書所為之撥款，或為申請人之利益或依申請人之指示而支付者。 We hereby unconditionally undertake and agree to repay the Bank all sums of money, advanced to us, or for our benefit, or upon our instructions, in accordance with this application. Seal is omitted when sending through Mizuho Global e-Banking 申請人經 貴行同意提前償還全部或部分借款時，亦應依 貴行銀行往來綜合約定書約定支付提前還款違約金。 In the event of full or partial repayment prior to the agreed maturity date with the Bank’s permission, in accordance with the General Credit Facility Agreement for Banking Transaction, we hereby agree to pay the agreed penalty in connection with such early repayment. 申請人證實申請外幣貸款之交易係為確實交易且未向其他金融機構申請融資。提供交易文件清單者，申請人茲證明清單所載資料有關交易屬實並留存原本供備查。 We hereby confirm that our application for the foreign currency loan is requested with respect to and will be used for genuine and bona fide trade activities of our company, and further confirm that no other financing has been obtained or requested from other institutions. If the trade information is given as a document list, we hereby confirm that all relevant information provided therein is true and genuine, and all originals are retained for audit.	本申請書為銀行往來綜合約定書之一部份，但本申請書與銀行往來綜合約定書不一致時，應優先適用本申請書之規定。 This application shall form a part of the General Credit Facility Agreement for Banking Transaction. However, if there is any discrepancy between this application and the General Credit Facility Agreement for Banking Transaction, this application shall govern. 申請人茲確認並同意本申請書內容，並願確實遵守本申請書約定。 ____________________________________ 申 請 人 簽 章 AUTHORIZED SIGNATURE(S) /SEAL(S) We hereby confirm and agree the items of the application, and agree to comply with the terms and conditions of the application.

主 管	經 辦	核 章
【FOR BANK USE ONLY】

(L6001) Electronic Application / Mizuho Global e-Banking Applicable 20180601

備註: 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。