CPD147R23
Print Blank Form Direct Debit Authorisation (for Credit Card
N N N N 1 CPD147W
Holder)
My/Our Signature(s)
Print
To 致： The Hongkong and Shanghai Banking Corporation Limited
Card Centre: PO Box 73730, Kowloon Central Post Office, Kowloon, Hong Kong
信用卡中心：香港九龍中央郵政局信箱 73730 號
DIRECT DEBIT AUTHORISATION 直接付款授權書
Note 注 意： 1. Please complete and return this authorisation to the above PO box address. 請填妥本授權書並寄回 上列郵箱地址。 Date day 日 / month 月 / year 年
2. As this automatic settlement of your account takes time to establish, please make payment as previously until 日期
advised. 由於閣下的戶口自動付款安排需時，故暫請繼續使 用原有方法付 款，直至 本行另行通知為止 。
3. 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。
4. *For UnionPay Dual Currency Diamond Card or UnionPay Dual Currency Card: *如用於銀聯雙幣鑽石 卡或銀聯雙 幣卡：
- Cardholder can settle the payment of the RMB sub-account with HSBC HKD or RMB account. 閣下可以滙豐港幣或人民 幣戶口繳付人民幣 子賬戶的款項。
- Separate Direct Debit Authorisation forms are required for the payment of HKD and RMB sub-accounts settled by HSBC HKD and RMB accounts
respectively. 如欲以滙豐港幣戶口繳付港幣子賬戶及人民幣 戶口繳付人民 幣子賬戶 的款項，請分別填 寫直接付款授 權書。
5. ^CNY is the currency code for renminbi (RMB). ^人民幣 (RMB) 的貨幣代號為「CNY」。
6. Please refer to the bank tariff guide for details of the charges. 收費的詳情請參閱銀行服務費用簡介 。
7. The direct debit authorisation is applicable to renewal/replacement card. 直接付款安排會適用於續 期／補發卡。
For Bank Use Only Party to be Credited (The Beneficiary) Bank No. Branch No. Account No.
銀行專用 HSBC's PVCCH S.I. Sundry CR Account 0 0 4 5 7 3 9 1 5 5 2 7 0 0 1
I/We hereby authorise 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. 本人（等）現授權本人（等）的下述銀行，〔根據受益人不時給予本人（等）銀行的指示〕自本人（等）的戶口轉賬予上述受益人。
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.
本人（等）同意本 人（等）的銀行毋須證實該等轉賬通知是 否已交予本人（等）。
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).
如因該等轉賬而令 本人（等）的戶口出現透支（或令現時的 透支增加），本人（等 ）願共同及個別承 擔全部責任。
I/We understand that I/we must maintain sufficient funds in the account one business day (before the close of branch banking hours) before the transfer date (as specified in the
instructions received by my/our Bank from the beneficiary and/or its banker and/or its banker's correspondent from time to time) for the transfer authorised herein. I/We agree that
should there be insufficient funds in my/our account to meet any transfer authorised herein, my/our Bank will be entitled, at its absolute discretion, not to effect such a transfer in
which event the Bank may levy its usual charges and may cancel this authorisation at any time without notification to me/us. For the avoidance of doubt, the Bank may cancel this
authorisation at its sole discretion at any time without prior notice. 本人（等）明白本人（等）須在指定的轉賬日期〔即根據本人（等）的銀行從收款人或其往來銀行及／或代理行不時收到
的指示〕前一個營業日（分行辦公時間內），在戶口內備有足夠款項以便支付該等授權轉賬。本人（等）並同意如本人（等）的戶口並無足夠款項支付該等授權轉賬，本人（等）的銀行有絕對酌情
權不予轉賬，且本人（等）的銀行可收取慣常的收費，並可隨時取消該等授權轉賬且毋須通知本人（等）。為避免疑問，本人（等）的銀行可隨時自行決定取消該等授權轉賬且毋須通知本人（等）。
This authorisation shall have effect until further notice. 本授權書將繼續生效直至 另行通知為止。
I/We agree that any notice of cancellation or variation of this authorisation 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. 本人（等）同意，本人（等）取 消或更改本授權書 的任何通知，須於取消／ 更改生效日最少兩 個工作天之前 交予本人（ 等 ）的 銀 行 。
The Bank may charge an instruction setup/amendment fee from my/our account stated below in accordance with the rates as specified by the Bank from time to time.
本人（等）的銀行 可根據不時規定的收費，向本人（等）的 下述戶口收取設立／更 改指示的費用。
My/Our Bank Name and Branch 本人（等）的銀行及分行的名稱 Daytime Contact Telephone No. 日間 聯絡電話號碼
STP
My/Our Name as recorded on Statement/Passbook 本人（等）在結單／存摺 上所紀錄的名稱 My/Our Signature(s) 本人（等）簽署
@#signStart1#@
My/Our Address as recorded on Statement/Passbook 本人（等）在結單／存 摺上所紀錄的地址
S.V.
Bank No. Branch No. *My/Our Account No. @#signEnd1#@
@#SVStart#@
銀行號碼 分行號碼 *本人（等）戶口號碼 HKD ^CNY USD
港幣 ^人民幣 美元 X @#SVEnd#@
For Bank Use Only 銀行專用 Submit paper form if debit other bank's account
Debtor's Reference Debtor's Reference Debtor's Reference
Add 增加 Change 更改 Delete 取消
Name(s) of Cardholder(s) 持卡人姓名 *Credit Card Account No. *信用卡戶口號碼
On the monthly due date, please make the following payment to my/our Credit Card account(s) 請於每月到期日支 付下列款項予本人 （等）的信用 卡戶口
#Amount of Monthly Payment 每月付賬金額
For Bank Use Only 銀行專用
}
Minimum Payment Due 最低付款額
(Please choose ONE option
結單結欠的 % of the statement balance (1 - 100%) 請選擇其中一項 ) Authorised Signature and Branch Chop
# Should the amount of payment calculated based on the percentage of statement balance be less than the Minimum Payment
Due of that particular statement month, the Bank will process the card payment with the Minimum Payment Due and debit
the amount from your designated account. If no percentage of the statement balance or multiple payment is specified by the
applicant, the Bank will process the card payment with 100% of the statement balance and debit the amount from your
designated account. 若以結單結欠的百分比計算的付賬金額少於當期月結單上顯示的最低付款額，本行會以最低付款額作為付賬金
額並從申請人指定戶口扣賬。若申請人沒有設定結單結欠的百分比為付賬金額，或申請人設定多項付賬金額，本行會以結單結欠的
100% 作為付賬金額並從申請人指定戶口扣賬。
For cardholders who have set up autopay for credit card repayment, HSBC will enable auto-adjustment of autopay debit
amount. After reducing credit transactions posted to credit card from last statement date, the adjusted amount will be
debited on the due date. 若持卡人已設立信用卡自動轉賬付款，滙豐將 會自動調 整閣下的自動轉賬 金額。自動轉 賬金額會 因應
上期月結單截單日 後被誌入信用卡戶口的入賬金額而有所調 整，經調整後 的應繳款 項將會於到期日從 戶口中扣除。
For the current cycle (after last statement), if cardholder instructed to set up or further amend the autopay for credit card
repayment, any further credit transactions (after this setup/amendment instruction) will not be auto-adjusted, unless
otherwise advised. 於本期月結單還款到期日前，如果因持卡人的要求設 立或再度 更改自動轉賬還款 金額，之後的 入賬金額 除另
行通知外均不會被 自動調整並於下期月結單恢復。
CPD147R23-m (030322) W TAB
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