711 申請書

Application Form to Register for Multiple Outbound Remittances of Foreign Workers Salaries/

Power of Attorney and Declaration of Foreign Exchange Settlement

I, whose details appear in the Consignor information section below, hereinafter as the Consignor, am a legitimate foreign worker immigrated into Taiwan bearing the valid Alien Resident Certificate.
I am not available to settle foreign exchange remittances at an authorized bank personally, thereby appoint Manstrong International Ltd., Uniform No. 28031525, address: No. 203, Yong An Road,
Younkang Dist., Tainan City; Telephone (06)254 3889 (the Company) as Consignee on my behalf to undertake foreign exchange settlements related to my salaries through the authorized bank. The
remittance must be delivered directly to designated recipient.
I further hereby register my details and those of my recipients for future remittance entrustment services through the Western Union Money TransferSM Entrustment Service for Migrant Workers
(Service). I understand that my details will be used by the Company to authenticate my identity. I also understand that my enrollment to the registration program will automatically suspend upon
expiration of my Alien Registration Certificate (ARC) provided to and verified by the Company. In such case, I shall provide the Company with my new ARC for re-verification.

4 Easy Steps to Register /

Step 1 / 1
Step 2 / 2
Provide personal information below (in English) as Consignor /

First Name (& Middle Name if applicable) / ()
Affix a photocopy of your valid ARC (Alien Resident Certificate) /

:
Last Name /
Mobile Phone No. in Taiwan /
Photocopy of ARC (Front)

()
(Please contact the Company to update mobile number if there is any change/)
Land Line No. of Residence (Optional) / ()
ARC (Alien Resident Certificate) Number / ARC
Step 3 / 3
Pre-register up to 3 recipients of remittances in English /
*Please note that recipients in certain countries (notably some African countries) are not permitted due to system limitations.
Please contact the Company for details / ()
Recipient 1 / 1
Last Name /
Receiving Country / ()
Indonesia
Vietnam
Philippines
Thailand
US, specify City & State
other, specify Country
Mexico, specify City, Province/State
, /
Recipient 2 / 2
Last Name /
Indonesia
Vietnam
Philippines
Thailand
, /
Recipient 3 / 3
Last Name /
Indonesia
Vietnam
Philippines
Thailand
, /
(Please contact the Company to amend or update recipient information / )
Step 4 / 4
Consents and Acknowledgements /
The Companys future remittance entrustment services may not used to, and I confirm that I shall not use such services to repay foreign loans taken out by me in order to work in Taiwan.
I understand that the Company will maintain the confidentiality of my information concerning this Application and Power of Attorney (including future remittance entrustment, if applicable) in
accordance with the Personal Information Protection Act and other applicable legislation. I agree that the Company may, for special purpose as shown on the reverse of this form, collect, process
on a computer, export and use my personal information and information on this Application and Power of Attorney, or disclose it to third parties. I also agree that, with respect to matters not covered
herein, you may handle my personal information and information on this Application and Power of Attorney in accordance with applicable regulations of the competent authorities, and that of your
and your cooperating partners involved in processing my Application and Power of Attorney (including future remittance entrustment, if applicable).
I hereby declare that I have reviewed the entire contents of all the terms and conditions regarding this Application and Power of Attorney as shown on the reverse, and that I fully understand them,
and my signature on this form indicates my agreement to these terms and conditions.
Signature of Consignor /
Date /
(YYYY/MM/DD, //)
Y
Please return the complete form to Manstrong via one of the following ways /
1.Hand in the form to Manstrong Service Locations /
2.Fax the form to (06) 255 2123 / (06) 255 2123
3.Mail the form to Manstrong International Ltd., No.455, Sec. 2, Changxi Rd., Annan Dist., Tainan City. / 455
You will be notified once your registration is validated and completed. Any questions, please call Customer Service Hotline at (06) 255 3877 / (06) 255 3877
The Registration Program (Program) is provided by the Company

on the following Terms and Conditions (Agreement)
1.Description of the Registration Program. This Program makes using the Service more convenient by allowing you to pay the entrusted remittance principal and
Service fee to the Company through authorized money collection service providers designated by the Company (Money Collection Service Providers) without
your having to attend Company locations each time you would like to perform a Service transaction. Also, the Program allows you to provide information about
yourself and about persons to whom you frequently send money (your Recipients) to the Company and a licensed Taiwanese foreign exchange bank (Bank),
Western Union (or, in some instances, its Agents, mobile phone provider or mWallet account provider) (collectively, Cooperating Partners). The Company will
store this information electronically so that it will be available automatically at Money Collection Service Provider locations at the time of making a Service
transaction. All Service transactions processed under the Program are subject to and will be processed under the terms and conditions of this Agreement as well as
the Service transaction terms and conditions which your must accept to process each Service transaction. In order to make any Service transaction (whether or not
you have been enrolled in the Program), you must comply with any applicable law and the Companys and its Cooperating Partners policies relevant to initiating
Service transactions in Taiwan at the time the Service transaction is made.
2.Initiating a Transaction. To initiate a Service transaction, go to any Money Collection Service Provider location and look for an automated kiosk machine.
Following the simple instructions on the screen by keying in the relevant information for the Service transaction. After you complete the Service request at the
automated kiosk machine, please present the Service request (as printed by the automated kiosk machine) to the cashier of the Money Collection Service Provider
and pay the relevant amount as indicated on the acknowledgement note to the cashier. The cashier will acknowledge receipt of the Service principal and any
Service fee(s) and charges(s) on the receipt after collecting the requisite amount from you. Please retain the receipt for your own safekeeping. If you have any
questions about your Service request, please contact the Company.
3.Registration Renewal. Your registration with the Program will be automatically suspended upon expiration of your Alien Registration Certificate (ARC) on
records with the Company. To reactivate your Program status, please provide the Company with your new ARC (or other appropriate documents confirming your
legal status in Taiwan) details and update your profile (if necessary). The Company will reactivate your Program status after successful verification of your profile.
4.Dormancy. If you do not send a Service transaction for a period of two continuous years, your participation in the Program may be suspended without notice.
5.Amendment. We may amend (change) the terms of this Agreement at any time. If any such amendment (change) will affect our usage of your or your Receivers
personal information stored by us, we will notify you when you next use the automated kiosk machine. Any such amendment (change) will become effective when
you use the Service after the amendment (change) is made. Details of the terms of this Agreement as amended from time to time will be made available to you from
the Company. At any time, you may also obtain a copy of this Agreement, as amended, by writing to the Company at the address below.
6.Limitation of Liability. TO THE MAXIMUM EXTENT PERMITTED BY LAW, THE TOTAL AMOUNT OF COMPENSATION FOR THE DAMAGES CAUSED BY THE COMPANY
AND COOPERATING PARTNERS FOR DELAY, NONPAYMENT OR UNDERPAYMENT IN PROVIDING THE SERVICE, WHETHER CAUSED BY NEGLIGENCE ON THE PART OF THE
COMPANY, COOPERATING PARTNERS OR THEIR RESPECTIVE EMPLOYEES OR AGENTS OR OTHERWISE, IF ANY, SHALL BE A REFUND OF THE PRINCIPAL AMOUNT
ENTRUSTED FOR REMITTANCE AND THE SERVICE FEE, PLUS DAILY INTEREST PAYMENT CALCULATED BASED ON THE FIXED ANNUAL INTEREST RATE FOR A ONE-YEAR
TERM DEPOSIT WITH THE TAIWAN POST CO., LTD. OR A 5% PER ANNUM INTEREST RATE UNDER ARTICLE 203 OF THE CIVIL CODE, WHICHEVER IS HIGHER TO THE
MAXIMUM EXTENT PERMITTED BY LAW, THE COMPANY AND COOPERATING PARTNERS SHALL NOT BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, OR
CONSEQUENTIAL DAMAGES NOT CAUSED BY THE COMPANY OR COOPERATING PARTNERS. YOUR TRANSACTION DATA IS CONFIDENTIAL AND SHOULD NOT BE
SHARED WITH ANY PERSON OTHER THAN YOUR RECEIVER.
7.Data Privacy. You agree that the Company may collect, computer process, use, and disclose your personal information to Cooperating Partners for THEM to
computer process and use. The information is used primarily by the Company and Cooperating Partners to complete your transaction and administer your Program
registration and participation. Without this information, your transaction and Program registration/participation may not be completed. The information disclosed
may include information describing your transactions with the Company; identification information, such as the name, telephone number, date of birth, arc number,
address and other information about you and your Recipients. You agree that the Company and Cooperating Partners may also disclose your personal information
to Taiwanese and foreign regulatory or law enforcement agencies where the Company and Cooperating Partners are authorized or compelled by law. Further, you
agree that the Company may transfer your information to Western Union for Western Union to use such information to contact you about other products and
services associated with Western Union.
Governing Law and Dispute Resolution. The rights and obligations under this application shall be construed in accordance with the laws of the Republic of
China. The Taiwan Taipei District Court shall have first instance jurisdiction over all legal actions or procedures arising from, or in connection with, this Agreement.
Customer Service Hotline of the Company (06) 255 3877

2011 WESTERN UNION HOLDINGS, INC. All Rights Reserved
Revised September 2011

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Application Form to Register for Multiple Outbound Remittances of Foreign Workers Salaries/

Power of Attorney and Declaration of Foreign Exchange Settlement

4 Easy Steps to Register /

Provide personal information below (in English) as Consignor /

Affix a photocopy of your valid ARC (Alien Resident Certificate) /

Mobile Phone No. in Taiwan /

Photocopy of ARC (Front)

Land Line No. of Residence (Optional) / ()

ARC (Alien Resident Certificate) Number / ARC

US, specify City & State

other, specify Country

Mexico, specify City, Province/State

US, specify City & State

other, specify Country

Mexico, specify City, Province/State

US, specify City & State

other, specify Country

Mexico, specify City, Province/State

(Please contact the Company to amend or update recipient information / )

The Registration Program (Program) is provided by the Company

Customer Service Hotline of the Company (06) 255 3877

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