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

[tv486462_ex10-27img1.jpg] 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

[tv486462_ex10-27img1.jpg] 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

[tv486462_ex10-27img1.jpg] Apply same interest rate until scheduled repayment
date    ¨ Revise each interest payment date

¨ Revise every __ months as of ____ MMDDYY

Interest Calculation Method [tv486462_ex10-27img1.jpg] 365 pro-rated  - ¨ 360
pro-rated / ¨ Include start and end dates - ¨ Include one of start or end date
If Repayment Date Is Holiday [tv486462_ex10-27img1.jpg] 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

[tv486462_ex10-27img2.jpg]

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.

 

 

 

[tv486462_ex10-27img3.jpg] 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