Samsung GEC, 500, Sangil-Dong, Gangdong-Gu, Seoul, Korea 134-090 Tel: 82 2 2053 2326 Fax:82 2 3458 4090 BANK ACCOUNT DECLARATION FORM [DATE] To: Accounting & Tax Dept Samsung Engineering Co., Ltd. □ This is to notify you (Samsung Engineering Co., Ltd.) of our Bank Account information to collect the payment of ours as below. Serial No. (SECL ONLY) Beneficiary Bank Name Bank Branch Bank Information Bank Country Account No. Currency Clabe Account Reference Number Company Seal APPLICANT : Designation: Ref. Only the person who is stated in the Business certificate or the POA(Power of Attorney) can be authorized to sign this form.
