開立存款戶申請書

APPLICATION FOR DEPOSIT ACCOUNT

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

（下稱「貴行」）

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

(Referred to as “Bank”)

申請人（如簽名頁所示，下稱「存款人」）擬在 貴行開立：

We (as indicated in the signature page, the “Depositor”) hereby agree to open deposit account as set forth below with the Bank：

支票存款戶 Checking account

定期存款戶（新臺幣及外幣）Time deposit account (NT Dollar, Foreign Currency)

活期存款戶 Demand deposit account（註 note）

（新臺幣 NT Dollar 外幣 Foreign Currency (幣別 )）

本存款帳戶，適用存款人於貴行帳號	之已約定印鑑（或署名）

The signature or seal for this deposit account is identical to the one registered with you for the deposit

account number

（註）本行活期存款原則為無存摺式活期存款，有關其對帳單之發行請參考存款約定書。
(Note)The demand deposit account of the bank is a statement demand deposit account. Please refer to the General Agreement for Deposit Acccount for the issuance of account statement.

並同意履行存款人與 貴行於中華民國 年 月 日簽署之存款約定書所規定事項。

and agree to the terms and conditions set forth in the General Agreement For Deposit Account signed between the Depositor and the Bank on (Day) (Month) (Year).

存款人: Depositor	簽 章： Signature and Seal
戶籍/登記地址: Residence/Registered Address
日 期: Date	（請蓋原留存印鑑） (Please affix the seal registered with the Bank)

OBU客戶聲明欄 For OBU Customer Only
本公司茲聲明本開戶申請並非經由貴行勸誘或非為投資特定商品而轉換為境外法人之身分所進行之開戶。 We declare that we open this account with the Bank solely at our own discretion, not subject to the inducement of Bank employees; and we do not convert into a qualified resident identity in order to meet the regulatory criteria of eligible financial products investor. 存款人簽章Signature and Seal
銀行處理欄 For Bank Use Only
支票存款戶開立時申請 Application for Opening Checking Account	事務	營業
副支店長	支票存款戶開立經緯、營業課意見Comment by BP (營業課意見可另以附件說明)	主管	經辦	課長	擔當
OBU境外法人之詢問客戶事項： 1.確認未有行員勸誘轉換居住者身分 2.確認未有推介存款人予代辦公司之情事 確認對象：(法人代表人、法人被授權人或開戶代理人) 確認日時： 確認者：

(G7053) Electronic Application 20191115

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。