Form of Amendment to Credit Agreement between STAAR Japan Inc. and Mizuho Bank Ltd
Exhibit 10.27
Loan Application (Market Fund-use)
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Mizuho Bank Ltd. |
Address 1-5-2, Irifune, Urayasu-shi, Chiba Prefecture Postal code ###-###-#### Name STAAR Japan LLC
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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 |
¨ 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 %)
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| Interest Payment Method |
¨ Prepaid on scheduled transaction date and __ day every __ months as of ____ MMDDYY ¨ Deferred payment on __ day every __ months as of ____ MMDDYY ¨___________________________________________
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| Revision of Applicable Interest rate |
¨ 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 | ||
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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 ###-###-#### 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.
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(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
