如亲临本公司签署，则无需填写本栏。

Applicable only if documents will not signed in our office.

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注：如果理赔申请人是主被保险人，则无需填写附属被保险人信息。

NOTE: If claim is for the Primary Insured, please do not fill out Dependent Information.

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请按以下说明将正确信息填写在一式两份的空白《太平洋卡自动转帐付款授权书》上，此张表无需填写。

Please fill in the correct information on the Authorization form according to the following instruction. No need to fill in this form.

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