Form A: At Counter Joint Credit Information Center Corporate credit report requisition ※ Basic Information Date of request： (Y) / (M) / (D) Delivery Method: Enterprise Responsible Person Chinese name: Chinese Name: English name: English Name: Business Administration Number:□□□□□□□□ IDCard No:□□□□□□□□□□ Domicile: Address of Registered Residence: □ □ Pick Up In Person By Mail (Address Contact No.:( ) Tel.:( ) (Mobile) Required document :All following documents are indispensable ＊For Companies:Original “Registration Form” or “Change Registration Form”Original ID card of the responsible person(but if you check “enterprise credit grading - including person in charge information”, please provide double ID documents)Seals of the company and its responsible person (same as the ones affixed on the company's Registration Form/Registration Change Form ＊For wholly owned businesses and partnerships: “business tax registration proof original” or “commercial ： registration transcript original”Original ID card of the responsible personSeals of the company and its responsible person ＊For other juristic persons: “unification notice original” or “business tax proof original”“court-issued the juristic person registration/change proof original” or “complete authority-issued permit or change to permit original ” or “registration proof original” or “tax authority-issued permit original” Original ID card of the responsible person Seals of the company and its responsible person Agent (This section is no letter of authorization; leave it blank if no agent is assigned.) Chinese Name: ID Card No.:□□□□□□□□□□ Contact No.:( ) The enterprise assigned an agent for apply on its behalf, the agent must provide its ID card and letter of authorization (the letter may be downloaded from the JCIC website for filling in or completed by the person in charge. But if “enterprise credit grading - including the person in charge information is chosen”, the person in charge must fill in the letter and affix his signature). ※Application Details ) 1. The fees for corporate credit reports are as follows: □Chinese copy: NT$300 □English copy: NT$400 □ Both copies: NT$600 □Chinese corporate credit report including “corporate credit grading”: NT$400 (A fee of NT$100 will be charged for each additional English or Chinese copy requested.) ◎ Purpose of application:(Check a maximum of two items) A.□ Credit review B. □Loan application C.□ Credit card/cash card application M.□ Profile check of a bidder O.□ Court litigation P.□ Review of Securities Listings (on TSEC/OTC/Emerging Stock Exchange) Q.□ Credit check by foreign banks R.□ Credit check by domestic business S.□ Credit check by foreign business T.□ Merger & Acquisition U.□ Reference for business cooperation V.□ Government Grant Application Z.□ Others (please specify) : 2. □ To add to the credit report the information on the reinstatement of a dishonored account, please submit a 2nd Category Inquiry Certificate issued by the Taiwan Clearing House. I hereby give my express consent and irrevocable authorization to JCIC to collect, use, and 2010.05.03. process with computer, pursuant to the Articles of Incorporation of JCIC, all personal data supplied by me for specific purposes within its registered business scope. I hereby certify that all the facts and information given in this application are accurate. Seal of the company and its responsible person (same as the ones on the required documents) : □ Signed by the principal in person Signature of Principal: □ Signed or sealed by the agent with Signature of Agent: authorization of the principal 2010.05.03.