授权书

Authorization Form

旅客本人授权签名：

Passenger authorized signature :

授权内容：

Authorization details: (Passenger name: Shin-Hua Liao passport number:

360203434 authorize ticket number 9992434524245 refund on the bank card below

and agree to take any consequence at all risks and all legal liabilities.)

（例如：本人同意将退款返还至此卡，并承担由此带来的风险和一切法律责任。）

银行名称(Bank’s Name)： Bank Austria

银行地址(The address of bank ):

SWIFT/BIC 号码(SWIFT/BIC Number)： BKAUATWW

账户号码（Bank account Number）:

IBAN 号码（International Bank Account Number）： AT41 1200 0100 1422 1526

账户持有人姓名(Card Holder name)： Shin Hua Liao

账户持有人地址(Card Holder address)： Florianska 3a/403, 03-707 Warsaw, Poland

乘客护照号码(passenger passport number)： 360203434

联系电话(contact number )： 0048 501 442 956

请附乘机人证件正反面照片(Please attach the passenger passport pictures of both sides):

请附账户持有人证件正反面照片(Please attach the card holder passport pictures of both

sides)