AUTHORISATION直接付款授权书day

到期或未有註明授權到期日。 I/We agree that any notice of cancellation or variation of this authorisation which I/we may give to my/our Bank shall be given at least two working days prior to the date on which such cancellation/variation is to take effect. 本人(等)同 意，本人(等)取消或更改本授權書的任何通知，須於取消/更改生效日期最少兩個工作天之前交予本人(等)的銀行。

4.

5.

6.

My/Our Bank Name and Branch 本人(等)的銀行及分行的名稱

Bank No. 銀行號碼

Branch No. 分行號碼 My/Our Account No. 本人(等)的戶口號碼

# My/Our Name(s) as recorded on Statement/Passbook #本人(等)在結單 / 存摺上所紀錄的名稱

Contact Telephone No. 聯絡電話號

+ Limit for Each Payment / * Month * 每次/月付款的+限額

+ Expiry Date (day/month/year) + 到期日 (日 / 月 / 年)

My/Our Address as recorded on Statement/Passbook 本人(等)在結單 / 存摺上所紀錄的地址

# Name of Debtor (if other than Account Holder) # 付款人名稱 (若非戶口持有人)

+ My/Our Signature(s) +本人(等)的簽署

+ Debtor Reference (Compulsory Field) + 付款人編號 (必填之欄)

X

x0cRemarks For Bank U Only 專用 *Plea delete whichever is not appropriate. * 請刪去不適用者。 Block Letters. # 請以英文正楷填寫。
+ Notes +附註

Branch Chop

銀行

#Plea write in

If the amount of your payments are likely to vary each time, t the Limit for Each Payment at the maximum amount you would expect to pay at any one time. 如台端付款的數額每次可能不相同，則請將最高者定為每次付款最高限額 每次付款最高限額。 每次付款最高限額 2. This Direct Debit Authorisation will be cancelled automatically on the date included in the box marked "Expiry Date". If you wish the Direct Debit Authorisation to have effect indefinitely (or until cancelled by you) plea leave box blank. 本直接付款授權書將於『到期日 『到期日』一欄中所填寫的日期自動撤 銷。如貴戶意欲直接付款授權書無限期有效(或直至貴戶予以撤銷為止)，則請將該欄留空。 3. Plea ensure that you sign the than in the usual way that you would sign on your Bank Account. 請保證貴戶在此授權書內的簽名，與銀行戶口所簽 者完全相同。 4. 5 In the box marked "Debtor Reference" enter the identifying reference between yourlf and the party to be credited i.e. Student No., Mortgage Agreement No.,Rental Agreement No., etc. 在『付款人編號』欄內，請將貴戶與受款一方的關係，略於說明，例如學生編號、抵押合約號碼等。 『付款人編號』

1.

If "Limit for Each Payment/Month" is not specified, the debtor's bank will t the limit as "unlimited". 如『每次/月付款的限額』一欄未有填上，付款銀行會將轉賬限額設定為”不設 上限”。 6. For HSBC customers, plea return the completed than to the Bank or mail to Autom