CCB (Asia) Visa Platinum Credit Card Application Form

Please return this application form when completed and signed to China Construction Bank
(Asia) Corporation Limited, G.P.O. Box 165 Central, Hong Kong, or fax it to 311 16117.

Sales I
Staff ID: L

Branch
Code: _

Credit Card A p p l i c a t i o n
16ACC/BT016A

/PSN1

Confibined Credit Limit (Applicable to existing cardmeimibers)

1 wouSd Bike to appEy f o r VSsa Platinum Credit Card (001)

!^^52

The credit limit of CCB (Asia) VISA/MasterCard Credit Card is combined credit limit, which will be shared
among all personal VISA and/or MasterCard Credit Card account(s}i of each cardmember. If you are an
existing CCB (Asia) VISA/MasterCard Credit Card cardmember and have submitted recent income proof,
the Bank will review and may increase your combined credit limit.
R e m a r k s : 1 . T h e c o m b i n e d c r e d i t limit Is n o t a p p l i c a b l e t o C o r p o r a t e Credit C a r d s a n d C C B (Asia) U n i o n P a y D u a l
C u r r e n c y C r e d i t Cards.

Other Instructions
I

Applicants must be permanent residents of H o n g K o n g and a g e d 18 or above, w i t h a rrtnimunn annual Income of no less than
HKD150,000 for Visa Platinum Credit Card,

ii. China Construction Bank (Asia) Corporation U r r t t e d (the "Bank") reserves t h e right t o issue any c a r d as it may, in its sole
a n d ^>soliJte discretion, determine.
IIL A n y a p p l i c a t i o n not meeting t h e annual I n c o m e r e q u i r e m e n t o f H K D 1 5 0 , 0 0 0 , m a y b e p r o c e s s e d a s if it is a Visa Classic
Card (101) application. Please Indicate if y o u w o u l d N O T a c c e p t s u c h a r r a n g e m e n t .
Not accept

t (Applicable t o Visa Platinum Credit Card only)

I w o u l d like to enrol Instant Travel Club

Billing address:
ATM screen instructkxi and S M S alert language (if any):

Residential EJ
Chinese

Direct mailing language:

Chinese

Ifthera tsnobcficatkxiof acklress/langLiageprBfererx^, y

effected in excess of the relevant c

ITre bank may at its sde discretion permit credit card 1
es arixl charges (induding_the HKD
limrt(s) and you shall be liable for such transaction{s)
Overlimit Fee). If you do not wish the Bank to peimrt transactionfe) made by the credit card
appiication
ara under tnis appiica
to be effected in excess of the relevant credit limit, please tick V " this box. Such choice wili also replace your
existing overlimit arrangement of the VISA/MasterCard combined credit limit (if appiicabie).

Please note: Even tf you have requested for the related arrangement, credit card transaction amount can still exceed credit limit
under certain circumstances (such as Octopus Automatic A d d Value Service, purchase of movie tickets which d o not require
authorization for effecting payment) and you shall be liable for such transaction and Overiinilt Fee.

Note: "Annual Insurance Plan" Is not applicable f o r c a r d m e m b e r s successfully enrolled with Instant Travel Club. For Terms &
CorKiitions o f Instant Travel Club, please refer t o our w e b s i t e o r related p r o m o t i o n leaflet.

Persoinal Data

Formef n a m e 1 Other n a m e (K any - pleasa.provide proof of fomw na/re/ other name)

HK Permanent ID Card no.

Place o f birth

Nationality

Date of birth
MV

D/

M aritals(N)
Single

Relatiionsihip with our Bank

Are/were you (1) (within the past 12 months) a director/a substantial shareholder/chief executive/employee
of any member of China Construction Bank G roup (CCB G roup') or "relative of o r trustee for any such
director/substantial shareholder/chief executive/employee? or (2) Are/wili you become in any way connected
with (i) a director of us or of any of our subsidiaries and/or associated companies; o r (ii) an entity controlling
10% or more of the shares of us or any director of such entity; or (iii) an indirect controller of us or any
director of such indirect controller?

English nama as printed o n H K Permanent ID Card (Surname first)

Chinese name

[C]

Office
English [U
English [ l

Number of

DlMarried

DiDivorced

Widowed

Relationship with that related person or company/entity

children

Education level (N)

Primary

Secondary

Vocational instrtute

Residential phone no.

University or above

No. I confirm that, as at the date of this application, I am not related to CCB G roup or your Bank as
mentioned in paragraphs (1) and (2) above. If I am so related after the date of this application, I shall
notify you in writing at once.

Mobile p h o n e no.

Remiinder of Required Documents

Please attach copies of the following documents to facilitate our processing. Documents submitted and
this application form will not be returned.

E-mail address (Required field)

Residential address {Please complete in English b l o c k letters) p.o. BOX win not be accepted

HK Permanent Identity Card of card applicant (If you are not a permanent resident of HK, copies of HK
Identity Card and a valid passport of your origin or visa are required.)

Current residential proof dated within t h e latest 3 months, e.g. electricity bill, rates d e m a n d
note, bank statement
Flat / R o o m

Floor

Block

and any one of the following documents:

BIdg. / Estate
i)

Latest 1 month's (latest 6 months' - if your main stream of income is on commission or overtime
allowance basis) salary slip(s) showing your name; or

No. and n a m e o f street

ii) Latest 3 months' bank statement I bank passbook showing your name, account number and salary; or
HK
District

DKLN

DNT

(Piease enclose permansnt address proof and state on the document

tl V)t
permanent
address Is different from tha above residential address)

Years there

Years at previous residential address

iii) Latest 1 month's Mandatory Provident Fund statement showing your name; or
iv) Latest Income Tax I Profits Tax Demand Note (within 1 year from the date of issuance); or
v) Latest Profits Tax Demand Note & Company and Personal bank passbook o f the latest 6 months,
if you are a sole proprietor of, or a partner In, a business.
The Bank may require the applicant to provide additional documents for approval.

Type of residence (N) (Please mark t h e appropriate b o x )

Live with parents
Quarters
M o r t g a g e / Rent per m o n t h
Public housing
Rented
O w n e d by applicant
Mortgaged
HKD

Declaratiion arid Signature

I do not wish the Bank to make use of my personal data for its own direct marketing (excluding credit
card products).
I do n o t w "

'-

Occupation
Name of employer {Please c o m p l e t e in English b l o c k letters)

fnformati'oh senFby the Bank, including but not limited t o cone

merchants promotion and other spending promotion programs.)
Please mark a '

Office Address (Please c o m p l e t e in English b l o c k letters) p.o. BOX win not be accepted

my personal data may be provided

to the Persona! Data (Privacy) Ordi

Flat 1 R o o m

Floor

Block

marketing ofthe classes

5f persons to which
Customers
imers relating
update the above choii

t: (1) I have read, u n d e r s t a n d a n d

agr<
By signing b e l o w o n this a p p l i c a t i o n f o r m , I c o n f i r m a n d acknowledge

a
i) Credit C a r d C a r d m e m b e r Agreement
Agreenrv
b o u n d b y (!) t h e terms a n d c o n d i t i o n s in this a p p l i c a t i o n a n d t h e C C B (Asia)
(key
'sions o f w h i c h are s u m m a r i z e d overleaf); (ii) t h e a t t a c h e d " N o t i c e t o C u s t o m e r s r e l a t i n g t o t h e Personal Data
) O r d i n a ince";
n c e " ; (2) N o loan / c r e d i t c a r d u n d e r m y n a m e h a s b e e n c a n c e l l e d d u e t o a d e f a u l t in p a y m e n t ar
iptcy
ently havtB n o overdue payment(s) e x c e e d i n g 3 0 d a y s in respect of any loan i n d e b t e d n e s s ; a n d (ii) no bankrupl
ation
r h a s ever been
teen m a d e against m e a n d I a m n o t petitioning o r planning t o petition for b a n k r u p t c y ; (3) All infonnati
provided in this iapplication
.
is c o r r e c t a n d c o m p l e t e , a n d I authorize y o u t o c o n f i r m or verify this i n f o r m a t i o n and m y e
r e redit
record in a n y w a y y o u c h o o s e .

BIdg.

No. a n d n a m e of street
HK

KLN

DNT

District
Nature of business

Office phone no.

Position

Years of service

Years of service at previous job

Monthly basic Income

Monthly Commission (If af^licable)

HKD

HKD

Setf-emp!oyed

DYes D N o

If seJf-empbyed, your years of

X
Signature of card applicant
For Office Use Only

DV

DE

QC

PV