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DIRECT DEBIT AUTHORISATION AMENDMENT/CANCELLATION FORM 直接付款授權書更改/取消表格 To: The Hongkong and Shanghai Banking Corporation Limited 致:香港上海滙豐銀行有限公司 Date 日期 D D M M Y Y Y Y Automatic Payments Centre, Payment Services: 匯款服務,自動轉賬中心: PO Box 72677, Kowloon Central Post Office, Kowloon, Hong Kong 九龍中央郵政局郵政信箱72677號 Note 注意:1. Please complete in Block Letters and tick where applicable. 請用正楷填寫,並在適當的地方加上剔號。 2. *If left blank, all authorisations in favour of the beneficiary will be cancelled. *如留空此欄,所有付款予收款人的授權書均予取消。 3. #Per Payment or Per Month (Only applicable for HKD). #每次或每月(只適用於港幣)。 4. Please notify the beneficiary of the changes. 請將更改的資料通知收款人。 5. You may amend/cancel the direct debit authorisation through HSBC Internet Banking. 您亦可透過滙豐網上理財更改/取消直接付款授權。 6. This form should only be used to amend or cancel the direct debit authorisations set up on HSBC bank accounts. Please contact the respective merchants directly to amend or cancel any direct debit authorisations that have been set up on HSBC credit card accounts. 此表格只適用於更改/取消經本行戶口過賬的直接付款授權指示。如欲更改/取消經 信用卡戶口過賬的直接付款授權指示,請直接聯絡有關商戶。 7. Your Direct Debit Authorisation amendment/cancellation request will normally be processed within 2 working days (excluding Saturday, Sunday and public holiday) upon receipt of your form. 在一般情況下,本行將在收到您的直接付款授權的更改/取消申請表後兩個工作天內(不包括星期六、日及公眾假期)處理您的申請。 8. The Bank may charge an instruction setup/amendment fee from your account stated below in accordance with the rates as specified by the Bank from time to time. Please refer to the bank tariff guide for details of the charges. 本行可根據不時規定之收費,向您的下述戶口收取設立/更改指示之費用。收費之詳情請參閱銀行服務費用簡介。 9. If left blank, all cancellation and amendment request indicated in this form will apply to all applicable currency. 如留空此格,本表內所填寫的取消及更改申請將會適用於所有合適貨幣。 I/We hereby request to amend/cancel the following direct debit authorisation(s) 本人(等)現更改/取消下述直接付款授權: Cancellation 取消 Name of Beneficiary 收款人名稱 *Debtor Reference *付款人編號 Effective Date 生效日期 1. D D M M Y Y Y Y 2. D D M M Y Y Y Y 3. D D M M Y Y Y Y 4. D D M M Y Y Y Y 5. D D M M Y Y Y Y Amendment 更改 1. Name of Beneficiary 收款人名稱 Debtor Reference 付款人編號 Effective Date 生效日期 D D M M Y Y Y Y Tick 剔號 Type of Instruction 指示類別 From To Debtor Reference 付款人編號 Payment Limit 付款限額 #Payment Frequency #付款周期 Expiry Date 到期日 D D M M Y Y Y Y D D M M Y Y Y Y Suspension Period 暫停期間 D D M M Y Y Y Y D D M M Y Y Y Y Reactivation of Direct Debit 恢復直接付款 2. Name of Beneficiary 收款人名稱 Debtor Reference 付款人編號 Effective Date 生效日期 D D M M Y Y Y Y Tick 剔號 Type of Instruction 指示類別 From To Debtor Reference 付款人編號 Payment Limit 付款限額 #Payment Frequency #付款周期 Expiry Date 到期日 D D M M Y Y Y Y D D M M Y Y Y Y Suspension Period 暫停期間 D D M M Y Y Y Y D D M M Y Y Y Y Reactivation of Direct Debit 恢復直接付款 Signature(s) 簽署 Account Name 戶口名稱 Contact Telephone Number 聯絡電話號碼 For Bank Use Only 銀行專用 Branch Chop Account Number 戶口號碼 Currency 貨幣類別 HKD 港幣 RMB人民幣 Staff ID APC070R19-m (230418) FW >> PSV-NSC S.V.

DIRECT DEBIT AUTHORISATION AMENDMENT ......Your Direct Debit Authorisation amendment/cancellation request will normally be processed within 2 working days (excluding Saturday, Sunday

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  • DIRECT DEBIT AUTHORISATION AMENDMENT/CANCELLATION FORM直接付款授權書更改/取消表格To: The Hongkong and Shanghai Banking Corporation Limited致:香港上海滙豐銀行有限公司

    Date 日期 D D M M Y Y Y Y

    Automatic Payments Centre, Payment Services: 匯款服務,自動轉賬中心: PO Box 72677, Kowloon Central Post Office, Kowloon, Hong Kong 九龍中央郵政局郵政信箱72677號Note 注意:1. Please complete in Block Letters and tick where applicable. 請用正楷填寫,並在適當的地方加上剔號。

    2. *If left blank, all authorisations in favour of the beneficiary will be cancelled. *如留空此欄,所有付款予收款人的授權書均予取消。3. #Per Payment or Per Month (Only applicable for HKD). #每次或每月(只適用於港幣)。4. Please notify the beneficiary of the changes. 請將更改的資料通知收款人。5. You may amend/cancel the direct debit authorisation through HSBC Internet Banking. 您亦可透過滙豐網上理財更改/取消直接付款授權。6. This form should only be used to amend or cancel the direct debit authorisations set up on HSBC bank accounts. Please contact the respective merchants directly to amend or

    cancel any direct debit authorisations that have been set up on HSBC credit card accounts. 此表格只適用於更改/取消經本行戶口過賬的直接付款授權指示。如欲更改/取消經信用卡戶口過賬的直接付款授權指示,請直接聯絡有關商戶。

    7. Your Direct Debit Authorisation amendment/cancellation request will normally be processed within 2 working days (excluding Saturday, Sunday and public holiday) upon receipt of your form. 在一般情況下,本行將在收到您的直接付款授權的更改/取消申請表後兩個工作天內(不包括星期六、日及公眾假期)處理您的申請。

    8. The Bank may charge an instruction setup/amendment fee from your account stated below in accordance with the rates as specified by the Bank from time to time. Please refer to the bank tariff guide for details of the charges. 本行可根據不時規定之收費,向您的下述戶口收取設立/更改指示之費用。收費之詳情請參閱銀行服務費用簡介。

    9. If left blank, all cancellation and amendment request indicated in this form will apply to all applicable currency. 如留空此格,本表內所填寫的取消及更改申請將會適用於所有合適貨幣。

    I/We hereby request to amend/cancel the following direct debit authorisation(s) 本人(等)現更改/取消下述直接付款授權:

    Cancellation 取消Name of Beneficiary 收款人名稱 *Debtor Reference *付款人編號 Effective Date 生效日期

    1. D D M M Y Y Y Y2. D D M M Y Y Y Y3. D D M M Y Y Y Y4. D D M M Y Y Y Y5. D D M M Y Y Y Y

    Amendment 更改1. Name of Beneficiary 收款人名稱

    Debtor Reference 付款人編號

    Effective Date 生效日期

    D D M M Y Y Y Y

    Tick 剔號 Type of Instruction 指示類別 From 由 To 至

    Debtor Reference 付款人編號

    Payment Limit 付款限額

    #Payment Frequency #付款周期

    Expiry Date 到期日 D D M M Y Y Y Y D D M M Y Y Y Y

    Suspension Period 暫停期間 D D M M Y Y Y Y D D M M Y Y Y Y

    Reactivation of Direct Debit 恢復直接付款 2. Name of Beneficiary 收款人名稱

    Debtor Reference 付款人編號

    Effective Date 生效日期

    D D M M Y Y Y Y

    Tick 剔號 Type of Instruction 指示類別 From 由 To 至

    Debtor Reference 付款人編號 Payment Limit 付款限額 #Payment Frequency #付款周期 Expiry Date 到期日

    D D M M Y Y Y Y D D M M Y Y Y Y

    Suspension Period 暫停期間 D D M M Y Y Y Y D D M M Y Y Y Y

    Reactivation of Direct Debit 恢復直接付款Signature(s) 簽署

    Account Name 戶口名稱 Contact Telephone Number聯絡電話號碼

    For Bank Use Only銀行專用

    Branch Chop

    Account Number 戶口號碼

    Currency 貨幣類別 HKD 港幣 RMB人民幣

    Staff ID

    AP

    C07

    0R19

    -m (2

    3041

    8) F

    W

    >> PSV-NSC

    S.V.

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