PDF《For Internal Use》

PrimeCredit WeWa UnionPay Diamond Card Application Form 安信WeWa银联钻石卡申请表格 1.

Applicant must be a Hong Kong Resident aged

18 or above. 信用卡申请人须为年满18岁之香港居民. 2. Full-time University / Tertiary Student applicant must be a full-time student of the University / Tertiary Institution designated by PrimeCredit, please refer to www.wewacard.com for related Institutions. 全日制大学 / 大专学生之申请人须就读於安信指定之香港全日制大学/大专院校, 有关指定之院校请浏览www.wewacard.com. 3. The approval of Credit Card is subject to the final decision of PrimeCredit. 信用卡之批核须视乎安信之最终决定 . Card Type 信用卡类别 WeWa银联钻石卡 WeWa UnionPay Diamond Card Please select one of the following Welcome Offers* 请选择以下其中一项迎新优惠*: Welcome Offer 迎新优惠 One set of Round-trip Standard Seat Flight Tickets for One Passenger from Hong Kong to Japan (Osaka or Okinawa) with HK$100 Hotel Voucher 单人来回日本(大阪或冲绳)标准客位机票一套及HK$100酒店礼券 C200 HK$600 H?agen-DazsTM Gift Voucher HK$600 H?agen-DazsTM 礼券 C196 HK$500 Cash Rebate HK$500 现金回赠 C197 Up to HK$90,000 Interest-free and Handling Fee-free Cash Instalment Program 高达HK$90,000 免息免手续费现金分期套现计划 C198 Personal Data 个人资料 Applicant who is currently holding or has held the credit card(s) of any card type(s) issued by PrimeCredit in the past

6 months is not eligible for any Welcome Offer. Please refer to the attached Terms and Conditions for details. No change of selected Welcome Offer is accepted. If no choice of Welcome Offer, or inapplicable Welcome Offer is indicated in this form, your Welcome Offer will be assigned as HK$500 Cash Rebate. 申请人如 於现在或过往6个月内曾持有任何由安信发行之信用卡,将不获赠任何迎新优惠.详情请参阅随附本申请表格的条款及细则.迎新优惠一经选定后将不可 更改.如申请人没有选择或选择不适用之迎新优惠 ,安信将代为选择HK$500现金回赠. * Please put a in the appropriate boxes below and fill in with BLOCK LETTERS 请於适当方格内加「 」号并以英文正楷填写下列各项 For applicant who selects Up to HK$90,000 Interest-free and Handling Fee-free Cash Instalment Program: 选择高达HK$90,000免息免手续费现金分期套现计划之申请人须填写以下资料U Please credit the approved Instalment Credit Amount^ to the following designated bank account in my name: 请将已批核之现金分期套现金额^存入本人名下之银行户口U Bank Name 银行名称: ^ Instalment Credit Amount shall be in maximum of HK$90,000 or shall not exceed 90% of the credit limit (whichever is lower) 套现金额高达HK$90,000或信用额之90% (以较低者为准) Please provide copy of your bank statement/ savings passbook of your Transfer Account bearing your name and account number. 请提供印有申请人姓名及转账户口号码之银行月结单/存摺副本. Bank No. 银行编号: Branch No. 分行编号: Account No. 账户编号: 【Exclusive for Full-time University / Tertiary Student 全日制大学/大专学生专享优惠】 HK$200 Cash Rebate+ HK$200 现金回赠+ C199 + Only required to spend HK$2,000 on eligible retail purchase transactions within

90 days from the card issuing date 只须於发卡后首90天内凭新卡合资格零售购物交易金额满HK$2,000 Notes 注U For Internal Use DS Code: PO EM AT ST Venue Code: FD IM CA P. Time: Any P D 日DM月MYY年YYEmail Address 电子邮件地址: Mr Ms 先生 女士 Family Name 姓Given Name 名Chinese Name Date of Birth 中文姓名: 出生日期: Hong Kong Place of Birth Identity Card No. 出生地点: 香港身份证号码 : Nationality Chinese (Hong Kong) Others 国籍: 中国香港 其他 Marital Status Single Married Divorced Others No. of Dependents 婚姻状况: 未婚 已婚 离婚 其他 供养人数: (Optional 可选填) Education Level Primary School Secondary Vocational/ Tertiary/University Others 教育程度: 小学 中学 Technical Institute 大专/大学 其他 职业训练/工业学院 Residential Address 住宅地址(P.O. Box is not accepted 恕不接纳邮政信箱): Flat/Room 室Floor 层Block 座Building/Estate 大厦/屋 No. and Name of Street 街道号数及名称 District 地区 HK KLN NT Years There YR(S) MTH(S) 香港 九龙 新界 已居住年数: 年月Home Tel. No. Mobile Phone / Pager No. 住宅电话号码: 手提电话/传呼机号码: Self-owned Mortgaged Rented Company Quarters Property Owned Public Housing Others 自置物业 按揭物业 租赁 公司宿舍 by Relatives 公屋 其他 亲属物业 Monthly Mortgage Instalment / Rental Payment (HK$) 元Applicant'