富卫人寿保险（百慕达）有限公司.PDFVIP

Direct Debit / Credit Card Authorisation Form 直接付款 / 信用咭付款授權書 Please complete and return this form to the party to be credited 請填寫並將此授權書交給收款之一方 Name and Account Number of the party to be credited (The Beneficiary) 收款之一方及其賬戶號碼（受益人） FWD Life Insurance Company (Bermuda) Limited 0 0 4 – 5 0 2 – 0 0 5 3 0 9 0 0 2 富 衛 人 壽 保 險（ 百 慕 達 ）有 限 公 司 I/We hereby authorise my/our below named Bank to effect transfers from my/our account to that of the above named beneficiary in accordance with such instructions as my/our Bank may receive from the beneficiary and /or its banker from time to time provided always that the amount of any one such transfer shall not exceed the limit indicated below. 本人/吾等現授權本人/吾等之下述銀行，（根據受益人或其往來銀行不時給予本人/吾等銀行之 指 示 ）自 本 人 /吾等之賬戶內轉賬予上述受益人。惟每次轉賬金額不得超過以下指定之限額。 I/We agree that my/our Bank shall not be obliged to ascertain whether or not notice of any such transfer has been given to me/us. 本人/吾等同意本人/吾等的銀行毋須證實該等轉賬通知是否已交予本人/吾等。 I/We jointly and severally accept full responsibility for any overdraft (or increase in existing overdraft) on my/our account which may arise as a result of any such transfer(s). 如因該等轉賬而令本人/吾等之賬戶出現透支（或令 現 時 之 透 支 增 加 ）， 本 人 /吾等願意共同及個別承擔全部責任。 I/We agree that should there be insufficient funds in my/our account to meet any transfer hereby authorised, my/our Bank shall be entitled, in its discretion, not to effect such transfer in which event the Bank may make the usual charge and that it may cancel this authorisation at any time on one week’s written notice. 本人/吾等同意如本人/吾等之賬戶並無足夠款項支付該等授權轉賬，本人/吾等之銀行有權不予轉賬，??銀行可收取慣常之 收費，並可隨時以一星期書面通知取消本授權書。