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To whom it may concern,

舉國泰世華銀行為例 同學您自己的名字

By my signature below, I agree to have my daughter/ son _______________ use the fund

in my _______________________________account for supporting her/ his Work & Travel

program in the United States during this summer vacation.

Please contact me if clarification is needed.


爸爸/媽媽的名字
Name: __________________________________________

Home/ Cell Phone Number: _________________________


爸爸/媽媽的
Address: ________________________________________
聯絡電話 & 聯絡地址
________________________________________________

Thank you,

________________________
請 爸爸/媽媽 用印刷體清楚寫下
Printed Parent/ Guardian Name
與護照上拼音相同之姓名

________________________
Parent/ Guardian Signature 請 爸爸/媽媽 用自己慣用的方法
簽下與護照上拼音相同之姓名

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