EX-10.27 3 tv486462_ex10-27.htm EXHIBIT 10.27

 

Exhibit 10.27

 

Loan Application (Market Fund-use)

 

 

Mizuho Bank Ltd.

 

Address     1-5-2, Irifune, Urayasu-shi, Chiba Prefecture

Postal code 279-0012

Name         STAAR Japan LLC

 

 

I am applying for the following transaction under the following terms and conditions.

Note that this document does not automatically constitute a financing agreement or pledge to finance.

To Wit

Details of the transaction (Indicated with ¡     the relevant ¨.)

Transaction Type Loan on bill     ¡    ¨ Special overdraft
Requested Transaction Amt
(Start amount with ¥)

Billion

¥

Million

5 0 0

Thousand

0 0 0

Yen

0 0 0

 
Scheduled Transaction Date  
Scheduled Repayment Date  
Repayment Method

 Lump sum payment on expiry

¨  First installment payment:       MMDDYY in the amount of: ________ yen.

Subsequently: Every __ months on ___ day in the amount of _______ yen.

However, the final payment is in the amount of: ________ yen.

Interest Rate

¨ Annually _____ %

¨ ______________ (             months) + annual               % (initial interest rate: Annually %)

 

Interest Payment Method

Prepaid on scheduled transaction date ¨ Deferred until scheduled repayment date

¨ Prepaid on scheduled transaction date and __ day every __ months as of ____ MMDDYY

¨ Deferred payment on __ day every __ months as of ____ MMDDYY

¨___________________________________________

 

Revision of Applicable Interest rate

Apply same interest rate until scheduled repayment date    ¨ Revise each interest payment date

¨ Revise every __ months as of ____ MMDDYY

Interest Calculation Method 365 pro-rated  - ¨ 360 pro-rated / ¨ Include start and end dates - ¨ Include one of start or end date
If Repayment Date Is Holiday Prior business day                          ¨ Following business day
Other Terms & Conditions  

 

End

 

 

 

(Bank-use Only)

If concluded by telephone after receiving submission of agreement when final decision on interest rate

- Time of call: Hour __ minutes __ date __

- Call to/from: Client - Mr./Ms. _________ Bank – Mr. Ms. ________

- Details of the call:

________________________________________________________

________________________________________________________

 

  CMR Approval No. Loan No.
     
 
Supervisor Verifier Manager
   

 

 

 

3601Y159 “Loan Application (Market Fund Use)” (Client) 16.06

 

 

 

Special Overdraft Refund Request (Overdraft-use only)

 

November 21, 2017 Please start amount with ¥.

Name

 

1-5-2, Irifune, Urayasu-shi, Chiba Prefecture

Postal code 279-0012

STAAR Japan LLC

Representative: STAAR Surgical AG

 

Amount  

Billion | 100 million | 10 million | million | 100 thousand | 10 thousand | thousand | hundred | ten | yen

¥500,000,000

Repayment Date (Note 1)

 

(Note 2)

February 21, 2018
Only enter requested account opening method

Overdraft

(Exclusive Account)

Account No.

     

Limit No.

 

     

(Request) Only write inside the heavily outlined sections.

 

 

 

Bank-use Only (note 1) If overdraft (exclusive account), repayment date need not be entered    (Note 2) Indicate date in four digits.

 

Transaction Client
Code
Approval No. Item No. Loan No.
(Copy from Execution Voucher)
Supervisor Verifier Manager
             
Ringi No.

Indicate with ¡ which is relevant

â         

â

 
            Special Special
(MML)

 

Execution Category New – Renewal Next Interest Deadline
(business day)
MMDDYY

(*) An objective party other than the operations person is to confirm that there is not discrepancy between the amount on the executed input voucher with seal affixed and the amount on the refund request form.

Mizuho Bank

Month end indication
code
Other than month end –
Month end
Interest Payment Cycle Lump Sum -
months
Holiday adjustment
code
Next business day -
Prior business day
Deadline Management
Category
Own Branch – Center
Interest withdrawal day day Next Interest Revision
date
MMDDYY – None
Bank base rate Mizuho TIBOR (      ) months - JBA TIBOR (     ) months - (     )

 

3603C069(5Y) (1 Set 100 Sheets) 16.03-Printing 103