致玉山银行香港分行.docxVIP

致玉山銀行香港分行To: E.Sun Commercial Bank Ltd, Hong Kong Branch結清帳戶申請書Account Closure Form申請日期:西元//(Application Date) (YYYY) (MM) (DD)*申請結清之帳戶餘額少於美金5,000，且支付餘額至存戶或持股100%之最終自然人股東同名帳戶，得免徵董事會會議紀錄。If account balance is less than USD$5,000 and transfer the balance to the account which is same name as the account holder or holding 100% shares ofultimate beneficial owner, Certificate of Board Resolutions is not required.戶名Account Name?????帳號Account Number活期帳戶Savings Account: 投資帳戶Investment Account:※保證金帳戶(如有)將一併結清Margin account(if any) will be closed also.支票帳戶Current Account: 本人/吾等/本公司附上未使用之空白支票據(支票號碼)繳回貴行，並保證在外已無流通票據，如有不實或致任何糾紛，其一切責任由本人/吾等/本公司無條件承擔，與貴行無關。I/We/Our company return unused cheque(s) No.with confirmationthat no cheque is outstanding for payment. If there is any dispute or legal liability arising from false information, I/we/our company hereby indemnify you from all consequences and all responsibility is borne by me/us unconditionally. 其他Others:本人/吾等/本公司同意貴行得於收到申請書正本、E-MAIL或傳真後合理作業時間內，以電話或其他方式確認本人身份後，辦理前開帳戶結清銷戶作業，如銷戶餘額不足支付相關費用(含以下指定處理方式之手續費，以下同)時，請貴行逕行辦理結清，本人/吾等/本公司同意放棄餘額，如貴行扣除相關費用後，仍有餘款時，本人/吾等/本公司同意貴行得依處理當下之匯率統一兌換為美金後，以下列指定處理方式支付:I/We/Our company hereby request you to close my/our account(s) with your bank after confirming my/our identity by the phone or other methods within a reasonable timeafter receiving Original, E-MAIL, or Fax copy. If the entire account balance is insufficient to pay relevant charges (including the charges of the following instruction) before closing the account, I/we/our company agree to give up the balance. If residual balance remains after deducting relevant charges, I/we/our company agree that your bank could exchange the balance to US Dollars and act according to the following instruction:銀行支票Bank’s Cheque開立以存戶或持股100%之最終自然人股東或持股25%以上之最終自然人股東為抬頭人之劃線禁止背書轉讓支票，並以快遞寄至下列地址：Please send the non-transferable cheque in favor ofaccount holder or holding 100% shares of ultimate beneficial owner or holding more than 25% shares of ultimate benef