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To: The Manager The Hongkong and Shanghai Banking Corporation Limited (Bangkok Branch) Date ___________________
CHEQUE BOOK APPLICATION where applicable
Account Name (s)
Type of Cheque Book
Account Number
Number of Books
Cheque Book(s) to be Collected at HSBC Bangkok Branch
Debit from Account Number ______________________ Paying by cash on requested date
Others _________________
I/We agree to be bound by the conditions subject to which cheque books are currently issued printed on the inside back cover of the cheque book. I/We hereby acknowledge the need to exercise care when drawing cheques and agree that I/we will not draw cheques by any means which may enable a cheque to be altered in a manner which is not readily detectable. I/We agree that I/we will collect the cheque book request from HSBC within 60 days from the date specified in the cheque book request form. In case that I/we do not collect the cheque book from HSBC within that period of time, I/we agree and acknowledge that HSBC is entitled to cancel my/our cheque book request. I/We hereby accept that HSBC has the right to charge/ debit my/our account with the cost of issuing the cheque book.
Signature(s)
(Identification) _____________________________ Mailed to me/us (to the statement address of the account) I/We hereby acknowledge receipt of the cheque book(s) specified above.
Signature of Recipient For Bank Use Only Signature Verified and Data Input Checked and Additional Information Date input by Verified/Approved by Low Cheque No.
