Cheque Book Request Form

I/We hereby acknowledge receipt of the cheque book(s) specified above. Signature of Recipient. For Bank Use Only. Signature Verified and Data Input Ch...

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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

Corporate 20 Leaf Bearer -THB A/C Corporate 100 Leaf Bearer -THB A/C

by me/us _________________________________

Payment Method of the Commission Fee

by (Name) ________________________________

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.

HUB109R1_BKH

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