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分期繳納申請書(Installment Application)

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  • 最後更新日期:108-9-18
  • 資料點閱次數:604

分期繳納申請書

Installment Application

(限金額新臺幣20萬元以下案件專用)

(Only for cases whose fee amountsare not exceeding NT$200,000)

執行案號Case number:                                                             承辧股別Section:

應納金額(利息及必要執行費用另計):                     元

Total fee amount (interest and enforcement expenses to be calculated separately):NT$ [-]                

申請人Applicant (即義務人Obligor)                        (負責人Responsible person:                ),因下列事由,無力一次繳納,請求以表列分期方式繳納,如有一期未按時繳納,貴分署得廢止分期,並願受強制執行。

Due to the following reasons, the applicant is unable to pay off the outstanding amount in one-time settlement and hereby applies for an installment plan. If the applicant fails to pay any installments on time, the branch can revoke the installment plan and proceed with compulsory enforcement.

  • (一) 現無工作或雖有工作但收入於支出家中生活費用後所剩無幾

Currently unemployed or employed but has nearly no money remaining after deducting living expenses.

  • (二) 家中有小孩或父母須扶養 Need to raise children or parents.
  • (三) 公司已結束營業 Company has ended its business operations
  • (四) 目前負債中Currently in debt
  • (五) 其他原因Other reasons
  • (六) 檢附文件Attachments

       (或另郵寄補送Or to be supplemented by postal delivery)

 

期別

Installment

繳納日期

Due date

分期金額

Installment Amount

繳納方式

Method of Payment

現金金額

Cash amount

支票號碼

Check No.

備註

Remark

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申請人Applicant:                                                      負責人Responsible person:   

(如係公司請蓋公司及負責人印章,個人請簽名蓋章

(If company, please affix company seal and seal of responsible person; if individual, please sign and seal.)

身份證ID Card No.:

住  址Address:

電  話TEL:

此致To

法務部行政執行署臺南分署

 Tainan Branch, Administrative Enforcement Agency, Ministry of Justice

 

中   華   民   國        年        月          日

Date of Application (DD/MM/YY)  _____/_____/_____ 

移送機關代理人簽章 Signature of Agent of the Referral Authority    

書記官Clerk            

行政執行官  Enforcement officer                

分署長或授權人員Director of branch or authorized officer

 

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