M/CS/DDAF/2911/1403/010

直接付款授權書

Direct Debit Authorization Form

收款人一方(受益人)

Name of party to be credited (The Beneficiary) 銀行編號

Bank No.

分行編號

Branch No.

收款賬戶之編號

Account No. to be credited

China Mobile Hong Kong Company Limited 0 2 4 2 6 3 2 2 4 0 4 0 0 0 2

1. 本人/吾等現授權本人/吾等之下述銀行，(根據受益人不時給予本人/吾等銀行之指示)自本人/吾等之賬戶內轉賬予上述受益人。

I/We hereby authorize 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 from time to time.

2. 本人/吾等同意本人/吾等之銀行無需證實該等轉賬通知是否已交予本人/吾等。

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.

3. 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/吾等願共同及個別承擔全部責任。

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).

4. 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，且銀行可收取慣常之收費，該等費用一概由本人/吾等支付。

I/We agree that should there be insufficient funds in my/our account to meet any transfer hereby authorized, my/our Bank shall be entitled, in its discretion, not to effect such transfer in which event the Bank may make the usual charge to be paid by me/us.

5. 本授權書將繼續生效直至另行通知為止或直至下列到期日為止(以兩者中最早之日期為準)。

This authorization shall have effect until further notice or until the below written expiry date (which shall first occur).

6. 本人/吾等同意，本人/吾等取消或更改本授權書之任何通知，須於取消/更改生效日最少兩個工作天之前交本人/吾等之銀行。

I/We agree that any notice of cancellation or variation of this authorization 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.

銀行編號

Bank No.

分行編號

Branch No.

本人/吾等之賬戶號碼 My/Our Account No.

本人/吾等之銀行及分行之名稱 My/Our Bank Name and Branch

本人/吾等在月結單/ 摺上所紀錄之名稱 My/Our Name as recorded on Statement/Passbook

本人/吾等在月結單/ 摺上所紀錄之地址 My/Our Address as recorded on Statement/Passbook

到期日

請參閱下列附註

Expiry Date (See notes below)

D D M M Y Y 本人/吾等之簽名 My/Our Signature(s)

日期

Date

債務之參考 客戶號碼 請參閱下列附註 3

Debtor’s Reference (Customer No.)

(See Note 3 below)

債務人之姓名 若非賬戶持有人 Name of Debtor (if other than account holder)

以下由銀行填寫

For Bank Use Only

Signature Verified

附註附註附註附註 NOTES 1. 本直接付款授權書將於 到期日 一欄中所填寫之日期自動撤銷。如 貴戶意欲本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。但 貴戶之銀行將不受此限，並可將超過兩年未有任何過賬記錄之直接付款授權宣布失效，及可刪除此授權記錄而無需另行通知。

This Direct Debit Authorization will be cancelled automatically on the date included in the box marked ‘Expiry Date’. If you wish the Direct Debit

Authorization to have effect indefinitely (or until cancelled by you) please leave box blank. If there is no transaction being recorded under this

Direct Debit Authorization for over two years, the Bank may delete this Direct Debit Authorization without giving any notice.

2. 請保證 貴戶在此授權書內之簽名，與銀行賬戶所簽者完全相同。

Please ensure that you sign the form in the usual way that you would sign on your Bank Account.

3. 請在此填上 貴戶流動電話服務月結單右上角客戶號碼點位後 6 或 7 位數 。如客戶號碼為 1.1234567，則只需填上 1234567。

Please fill in the 6 or 7 digits number after the dot of Customer No. stated at the top right corner of your mobile service Monthly Invoice. If your

Customer No. is 1.1234567, only 1234567 need to be filled in.

(英文文本與中文譯本文義如有歧異，概以英文本為準。)

填妥本授權書後填妥本授權書後填妥本授權書後填妥本授權書後，，，，請交回請交回請交回請交回 貴戶之往來銀行貴戶之往來銀行貴戶之往來銀行貴戶之往來銀行

Please complete and return this form to your banker

流動電話號碼

Mobile Phone No.

M/CS/DDAFG/2911/1403/007

“直接付款授權書直接付款授權書直接付款授權書直接付款授權書 ” 填表指引樣本填表指引樣本填表指引樣本填表指引樣本

(此乃樣本，不可當作直接付款授權書使用，請勿交予銀行)

申請自動轉賬繳交月費注意事項申請自動轉賬繳交月費注意事項申請自動轉賬繳交月費注意事項申請自動轉賬繳交月費注意事項：：：：

申請自動轉賬方法

♦ 客戶須填寫 直接付款授權書 並交予有關銀行申請。

♦ 如表格上有任何塗污或刪改，賬戶持有人須在旁邊加簽。

♦ 影印本恕不接受。

♦ 申請需時約 6 至 8 星期，但注意最後自動轉賬被銀行接納與否，以銀行之決定為依歸。

確認自動轉賬生效

♦ 如自動轉賬已生效，則於 自動轉賬日期及金額 一欄會列印於賬單的下方以作確認。本公司將根據客戶指示，在指定之銀行賬戶扣除賬單上應繳款項。但生效前，客戶請以其他付款方式繳付月費(詳情請參閱月結單背頁)。

♦ 如欲查詢批核情況或拒絕申請之原因，請致電有關銀行。

分 行 編 號 (xxx) – 至 賬 戶 號 碼 (xxxxxx-xxx) 印於銀行 摺/賬單/提款卡 上。如若不清楚銀行編號，請向銀行或中國移動香港門市職員查詢

記錄在銀行之通訊地址

呈交表格之日期

賬 單 右 上 角 客 戶 號 碼

(Customer No.) 點數位後 6

或 7 位數 。如客戶號碼為1.1234567，則 只 需 填 上1234567

申請直接付款之中國移動香港流動電話號碼

若銀行賬戶持有人與流動電話客戶不相同，此欄請填寫流動電話客戶之姓名

請參閱 附註 1

銀行賬戶之持有人名稱

自動轉賬之銀行及分行名稱全寫

銀行賬戶持有人(等)之簽名。請勿超越格外。簽名須與銀行賬戶所簽的完全相同；或請參閱 附註 2

M/CS/DDAFG/2911/1403/007

“Direct Debit Authorization FormDirect Debit Authorization FormDirect Debit Authorization FormDirect Debit Authorization Form” InstructionInstructionInstructionInstruction

(Sample only and cannot be used for direct debit authorization. Do not submit to bank.)

Remarks on registration of Direct Debit

How to register for Direct Debit

♦ Customers have to fill out and return the “Direct Debit Authorization Form” to relevant bank.

♦ If any amendment is made on the form, bank account holder has to countersign next to the amendment.

♦ Photocopy is not accepted.

♦ Please allow 6-8 weeks for processing your application. The acceptance of your application will be decided by the bank.

Confirmation of the effectiveness of Direct Debit

♦ If autopay is activated, [AutoPay Amount Due] will be printed at the bottom of the statement for confirmation. We will debit the Amount

Due from the assigned bank account according to your instruction. Please use other payment methods to settle the bill before the

autopay is activated. (Please refer to the back page of the invoice)

♦ If you want to check your application status or the reason of rejecting your application, please contact relevant bank.

Branch No. (XXX) – Account No. (XXXXXX-XXX) printed on passbook/ statement/ ATM card. To check branch no., please contact bank or CMHK Shop staff.

Correspondence address recorded by Bank

Submission Date

The 6 or 7 digits after the dot of the customer no. stated at the top right corner of the statement. If customer no. is 1.1234567, only 1234567 need to be filled in.

CMHK mobile phone number registered for direct debit

If the names of bank account holder and mobile phone service customer are different, please fill in the name of mobile phone service customer here.

Please refer to <Notes 1>

Name of bank account holder

Bank account holder(s) signature(s). Please sign inside the box and the signature should be identical to that for bank account; or refer to <Notes 2>.

Full name of Bank and Branch for autopay service