┌────┬─────────────────────────────┐    │證券種類│                                                          │    ├────┼─────────────────────────────┤    │數    量│                                                          │    ├────┼─────────────────────────────┤    │指定價格│                                                          │    ├────┼─────────────────────────────┤    │預存金額│                                                          │    ├────┼─────────────────────────────┤    │現 定 期│                                                          │    ├────┼─────────────────────────────┤    │限    期│                                                          │    ├────┼─────────────────────────────┤    │備    考│                                                          │    └────┴─────────────────────────────┘　　上列證券委托 貴公司買入請即依照 貴公司代買證券規則辦理此致上海信托股份有限公司　　臺照　　                                                 （簽名蓋章）　　委托者：　　信 址　　                                                   年 月 日