1、<p>　　申請(qǐng)人姓名或名稱/代表人或負(fù)責(zé)人姓名：</p><p>　?。ˋpplicant’s Name/ Head of Organization）：</p><p>　　中文（in Chinese）：_________________________________________________________________________</p><

2、;p>　　外文（in Foreign Language）：_________________________________________________________________</p><p>　　2.護(hù)照、其他身分證明文件號(hào)碼或法人營(yíng)利事業(yè)登記證號(hào) 3.電話 (Tel No.)： </p><p>　　(Passport /ID No. or Comp

3、any Registration No.)：</p><p>　　______________________________________________ ____________________________________</p><p>　　4.出生日期(Date of Birth)：5.性別(Sex)： </p><

4、;p>　　6. 地址(Address)： 7.電子郵件信箱（E-mail）：</p><p>　　___________________________________________________ _____________________________________</p><p>

5、;　　8.申 請(qǐng) 文 件 證 明 用 途 (Purpose of Authentication):</p><p>　　___________________________________________________________________________________________</p><p>　　9.所 繳 文 件 (Document(s) or Certi

6、ficate(s) Attached to the Application Form):</p><p>　　___________________________________________________________________________________________</p><p>　　10.申請(qǐng)人簽名： 11.申請(qǐng)日期：</p>&l

7、t;p>　　Signature： Date of Application：______________________</p><p>　　注意： 申請(qǐng)表內(nèi)各項(xiàng)資料，務(wù)請(qǐng)逐項(xiàng)據(jù)實(shí)詳細(xì)填寫，並請(qǐng)繳驗(yàn)身分證明文件，其透過(guò)代理人申請(qǐng)者，並應(yīng)繳交經(jīng)公證人或公務(wù)機(jī)關(guān)認(rèn)證</p><p>　　授權(quán)人簽字屬實(shí)之授權(quán)書，否則將被

8、拒絕受理；所填寫內(nèi)容倘有不實(shí)，申請(qǐng)人及代理人將可能觸犯中華民國(guó)刑法之偽造文書罪。</p><p>　　Attention: </p><p>　　Applicants must complete all sections of this form truthfully and in full. The relevant ID documents must be submitted toge

9、ther with the </p><p>　　form. If the application is submitted through an agent, power of attorney authenticated by a notary public or the appropriate </p><p>　　authorities must be attached, or t

10、he application may be refused. Should any false or misleading information be willfully entered on</p><p>　　this form, this will constitute an act of forgery according to the Criminal Code of the Republic of