outward Remittance form

FCC ID: QLE-GUW2015V

Attestation Statements

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FCCID_993260

1C040—1 ®@ 4 4# & BR 4#A tf wEX=w TAIWAN COOPERATIVE BANK Bh—BB c iool inE MCrArENR E & @ _,grk $ _‘::%_ %— th—BH : @BGRErHrCnte SB : #5Roieoim Outward Remittance Application Form (HnEEAHRNGESAERILONCIN K ¥Un tBR : i t a aty : 970804 Date : 0 tX#x 4& &4 $4 9t i M ol “F' applicant‘s name SPORTON INTERNATIONAL INC _i_ Kok &A TB 5 1. c ak on d 6 mss — it 106 3t 6 i B # C sA 6F, No. 106. Hsin Tai Wu Rd., Sec.1, Hsi Chih. & /\ Taipei Hsien, Taiwan 221, R.0.C. TEL:26962468 § _ |address and telephone no A 2 > € 1. |m —witle e /b re/®mat : 974910093 5 § enterprise registration/resident LD. card/passport no/mationality 'mi > |serexk: %L t &4A a : date of birth c Cb mA 19 s e i o mt 6 ie o > w 5 10040—2) &4 : FCC/AC T Beneficiary & E mg#s (nm A |soak : > |Oi® Cw) EK |stdressct #i Or® (Bankprart) A i Ox#k® (1c) 5z |59 fk#k : 27000001 7 i Qars» (casn) § faccountno. * |O#NRE#—# ( foreign exchange deposit) & d O#%# : 7 [57 # R4RAF A Biik . account with inst. ;k' athers [TREAS NYC C i 6 N6 4s mb 70 T & (deailsofpayment) : FCC ID:QLE. FCC &0 8 |m thym #} B 5 #6¢ CODE1:QLE—GUW201 5V. FCC local foreign exchange deposit CODE?:13EA776665/FCC CODE 1:UZ7AP7131.FCC u 3 Oxtfa® CODE 2:13EA251435 EK & traveter cheques i O#¥#as# ___ & cash(in foreign currency) 5 o4# ks dtaictk RikERS: USbis6(E®A 7 $ |Oiornmredks remittance amount C# & m# m ;{ inward remittance KARMAMAH : 19D COs# : (nature of remittance ) others C131 fha 4 i 0132 i0 36 & i 133 r ie & i C510 w it m ik (fk & exchangerate (1¢ 5 M 5 f 23 C602 # A ME Ge fhak s M# o s 700 Exk o D]Aik t c ie o fihtk 4 sttd9t) @ h CcPa c hy B S5 #A & 2 41 remitee‘s status ssee enc uol yq (destination of remi@0E®). |oovermment gnv:mm;l—owned enterprise others + handfi“ m # NTS . $ (cl:x/fil fees *# NTS Wikintr (C#l#kRdT : plLbiPw® 7B $50606—03FR &A #i#6#/821502—02FR ##5 # 491.


Document Created: 2008-08-29 16:54:52
Document Modified: 2008-08-29 16:54:52
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