Global Transfer Application Form
Total Page：16
File Type：pdf, Size：1020Kb
GLOBAL TRANSFER APPLICATION FORM Please complete the application in English and block letters and submit the FULL set of application. 1. Membership Rewards Program FOR OFFICE USE ONLY You will be automatically enrolled free into the Infinite Rewards program to earn unlimited Membership Rewards points when spending with The Centuion® . Every HK$1 spent in SPID: 25W LOGO: 8Ø 6 PCT: 2SE Hong Kong earns you 1.5 points and every HK$1 spent abroad earns you 3 points. Points SC: KNBØ3ØXBØ4 accrual is subject to the American Express Membership Rewards Terms and Conditions. 3. Your job Do you want to transfer all existing Membership Reward MM:BØØCPP DEL:NORA points in your Overseas American Express Card Account Company Name to your new card ? Yes No Office Address Flat/Rm Floor Block 2. Your personal particulars Building Applicant must be a Hong Kong or Macau Resident /Citizen aged 18 or above. Name should be same as the one on your HKID Card. Road/Street Mr Ms Miss Surname First Name District/ Area City HK MACAU Please show my name on the Card as below (maximum 20 characters): Years There YY MM Office Phone No. Self Employed Are you a Hong Kong permanent resident? No Nationality Position Nature of Business 1 HKID Passport HKID/Passport Number Your financial data Date of Birth DD MM YYYY Annual Income (HK$) X Months Education * Secondary(S) Tertiary(T) University or above(U) If you have other income, please indicate one and specify amount (HKS) Property (PRP) Cash deposit/ Saving (CDS) Investment (INV) Home Address Flat/Rm Floor Block Annual Business Net Profit (ABN) Spouse Income (SPI) Building Total Annual Income (HK$) Road/Street 4. Your overseas American Express Card Account No. — — District/ Area City Country of Issuance : _______________________________ HK MACAU Please indicate your intention for your Overseas American Express Card Account : Years There YY MM Retain Give up* Rent(R) Live with Parents/ Relatives(P) Company Quarters(C) * Your overseas American Express Card will be closed upon approval of your new Card. Any unused portion of the annual fee last billed to your overseas American Express Own Property(O) Mortgage(M) Card will be credited to that Card Account. Your new Card annual fee will be billed Please provide permanent address proof if the permanent address is different from with your first statement. the above residential address. Mobile No. Home Tel.* 5. Bank Information Bank Name Correspondence Language Preference Chinese(CH) English(EN) Billing Address Home(H) Office(B) Bank Account No. Email Address 6. Your Signature 1 For Hong Kong permanent ID cardholder, please provide HKID no. and copy of HKID. By signing below, I/we acknowledge that I/we have read and agree to the Declaration, Otherwise, please provide passport no. and copy of both HKID and Passport. Important Information about the card, and other terms and conditions enclosed with this application form. Please indicate when you would like to receive your statement Beginning Middle End of the month Signature of The Basic Centurion Card Applicant The Centurion Additional Card SUPP IND: 1 Please tick here if you wish to apply for The Centurion Additional Card to separate your business and personal expenditure. Date Please return the completed application form by fax to 2811 7357. 0416 *The field is optional. 30_GT_CN_E_ 19A48 Page 1 of 4 Applicant is required to fill in the following: Name of Basic Card Applicant : _________________ HKID/Passport No. : _________________ 7. Give your loved one a free Centurion Supplementary Card 1 3 8. Give your loved one a free Supplementary Card 1 3 Supplementary Cardmembers must be aged 18 or above. Up to 2 Centurion Supplementary Supplementary Cardmembers must be aged 18 or above. Up to 2 Centurion Supplementary Cards are allowed per account. Cards are allowed per account. You can apply up to 4 other Supplementary Cards. Please Please indicate your intention for your existing Supplementary Card(s). advise your choice of Supplementary Cards as below. Cancel Transfer Please indicate your intention for your existing Supplementary Card(s). Mr Ms Miss SUPP IND: 3 Cancel Transfer Name should be same as the one on your HKID Card. Platinum Card Gold Card American Express Card SUPP IND: 5 SUPP IND: 6 SUPP IND: 7 Surname First Name Mr Ms Miss Please show my name on the Card as below (maximum 20 characters): Name should be same as the one on your HKID Card. Are you a Hong Kong permanent resident? No Nationality Surname First Name 1 Please show my name on the Card as below (maximum 20 characters): HKID Passport HKID/Passport Number Date of Birth DD MM YYYY Are you a Hong Kong permanent resident? No Nationality Contact No. Relationship 1 I accept all terms and conditions in this application and accept liability with the Basic HKID Passport HKID/Passport Number Cardmember for all charges on any Supplementary Card issued to me. Date of Birth DD MM YYYY Signature Contact No. Relationship I accept all terms and conditions in this application and accept liability with the Basic Cardmember for all charges on any Supplementary Card issued to me. Signature Date Give your loved one a free Centurion Supplementary Card 2 3 Supplementary Cardmembers must be aged 18 or above. Up to 2 Centurion Supplementary Date Cards are allowed per account. Please indicate your intention for your existing Supplementary Card(s). Cancel Transfer 9. Documents required Mr Ms Miss SUPP IND: 3 To expedite processing of your application, please attach and indicate in the boxes Name should be same as the one on your HKID Card. below copies of document4 enclosed. Surname First Name HKID Card or Passport (the page with photograph) for both Basic & Supplementary Card applicants5 Please show my name on the Card as below (maximum 20 characters): Residential address proof and permanent address proof (if any) within the latest 3 months, e.g. Utility bill, bank statement or Telecom bill Are you a Hong Kong permanent resident? No Nationality 3 Please enclose residential address proof if supplementary card applicant‘s 1 HKID Passport HKID/Passport Number residential address is different from that of basic cardmember. Please also provide permanent address proof if it is different from the residential address. New card Date of Birth DD MM YYYY will be mailed to the basic cardmember’s correspondence address. Contact No. Relationship 4 All copies of documents will not be returned. We may request for further I accept all terms and conditions in this application and accept liability with the Basic documentary support as we deem necessary in order to process your application. Cardmember for all charges on any Supplementary Card issued to me. 5 Basic Card applicant shall sign on the copy as signature proof. For Hong Kong Signature permanent ID cardholder, please provide copy of HKID Card. Otherwise, please provide copy of both HKID Card and Passport. HKID copy: Please enlarge to 150% and choose a lighter colour mode. Date 0416 30_GT_CN_E_ Page 2 of 4 Applicant is required to fill in the following: Name of Basic Card Applicant : _________________ HKID/Passport No. : _________________ IMPORTANT: The Basic and Supplementary Card Applicants must read this information and sign overleaf. OPT – OUT REQUEST : MARKETING PROMOTIONS (i) American Express International, Inc. (“Amex") wishes to use your name, telephone number, email address, mailing address, financial background, demographic data, products and services portfolio information and transaction pattern and behavior for direct marketing to you of: (a) credit/charge card, insurance and travel related products and services; (b) reward, referral, loyalty or privilege programmes and related products and services; and (c) Cardmember benefits, promotional offers* and products and services offered by Amex, American Express Company and its subsidiaries and affiliates (collectively, “Amex Group”), and Amex’s merchants, business partners (including third party insurance companies and reward, loyalty, privilege programmes providers), co-brand partners and affinity groups (such merchants, business partners, co-brand partners and affinity groups, collectively, "Amex Partners"). (ii) Amex also wishes to provide your name, telephone number, email address, mailing address, products and services portfolio information and transaction pattern and behavior to Amex Group companies and Amex Partners, including for Amex's gain, for direct marketing by them to you of the products, services and subjects mentioned in (i)(a) to (i)(c) above. (iii) Amex, Amex Group companies and Amex Partners may also, from time to time, engage third parties to provide marketing services on their behalf, and may share your name, telephone number, email address, mailing address, financial background, demographic data, products and services portfolio information and transaction pattern and behavior with them for such purposes. (iv) Amex may not use or provide your personal data as described above without your consent. Should you find any such use of your personal data not acceptable, please indicate your objection to the use of your Personal Data for direct marketing by either checking the box below or calling the telephone number or changing your marketing preferences online as provided for below. (v) If your application is declined or cancelled, Amex will not use or share your personal data for direct marketing purposes, unless you have previously provided instructions to Amex on marketing in respect of your existing card relationships with Amex (if any). Opt-out By checking this box, I am instructing Amex not to use my personal data for direct marketing purposes in relation to the Amex product that I am applying for (“my Opt-Out Instruction”). If I have existing relationship(s) with Amex and/or other Amex Group companies, I understand that my Opt-Out Instruction does not override my previous instructions to Amex and/or Amex Group companies on marketing in respect of such existing relationships.