學員體檢證委託代領登記表 / Application for Proxy Collection of CAA's Medical Certificate
注意事項：
若需委託安捷航空代領個人CAA體檢證者，請先完成轉帳新台幣250元(CAA發證費用)至以下帳戶，再填寫本份表單，並來電02-87971686 分機8888 
If you need to authorize APEX Aviation to collect your personal CAA medical certificate on your behalf, please complete the transfer of TWD$250 (CAA issuance fee) to the following account before filling out this form. For further assistance, please call 02-87971686 extension 8888.


【匯款資訊】
戶名：安捷航空股份有限公司
銀行：中國信託（822）承德分行
帳號：6245-4367-8896

[ Remittance Information ] 
Account Name: Apex Aviation Inc.
Bank: CTBC Bank (822), Chengde Branch
Account Number: 6245-4367-8896

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姓名/Full Name
性別/Sex
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身份證字號/ ID or Passport No.
出生年月日/ Date of Birth
範例: 1984/09/29
體檢證和報告類別/ Type of Medical certificate & Report
聯絡電話/Contact No.
電子信箱/Email
匯款帳號後五碼/The last five digits of the remittance account number
備註/Remark
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