Year 2008 - Insurance Industry after current finanical tsunami

Type of Membership Applied (Please refer to the membership definition stated below before completion) □ Individual Member □ Individual Associate Member □ Individual Associate (Student) Member Individual Member (Entrance Fee: HK$200; Annual Subscription: HK$150) or Individual Associate Member (Entrance Fee: HK$200; Annual Subscription: HK$150) or Individual Associate (Student) Member (Entrance Fee: Waive; Annual Subscription: HK$50) Name : Mr / Mrs / Miss : Name in Chinese (if any): Date of birth : Nationality : Passport / ID number : Name of company : Correspondence address : Tel : Fax : E-mail : □ I am a registered agent / authorised broker in compliance with the law of Hong Kong. □ I am a person whose business activities are closely related to the Insurance industry. □ I am a person whose studies full time on subjects related to Insurances or Financial services in education institution. Position Held : Experience in insurance field: since (year) : Insurance qualification (if any): ( )FCII ( )ACII ( )ANZIIF ( )FLMI ( )CLU Others: (please specify) : My main line of business : General / Life / Composite Insurance Others : I/We, the undersigned hereby apply for admission to become Individual Member / Individual Associate Member / Individual Associate (Student) Member of the Hong Kong Chamber of Insurance Intermediaries and agree to comply with all the regulations as set by the Chamber from time to time. I/We understand that the acceptance of my /our application is subject to the final approval of the Executive Committee of the Chamber. My / Our membership fee made payable to Hong Kong Chamber of Insurance Intermediaries is herewith enclosed as follows : Bank name : Cheque number : Amount (HK$) : Signature of applicant (With company chop where appropriate) Proposer : Name : Date : Note: “ Individual Member ” - is an insurance intermediary who represents himself in person in the Chamber and duly accepted by the Chamber. “ Individual Associate Member ” - is a person whose business activities are closely related to the Insurance industry and duly accepted by the Chamber. “ Individual Associate (Student) Member ” - is a person whose studies full time on subjects related to Insurances or Financial services in eductaion institution and duly accepted by the Chamber. Please tick this box if you do not want your personal details to be made available to the public. For office use only Date received : Date ack. sent : Membership No. Assigned Date approved : Date cert. sent : Individual Membership due date : Ind. Associates Remarks : Ind. Associates (Student) Membership Appl ication Form(B) INDIVIDUAL MEMBER / INDIVIDUAL ASSOCIATE MEMBER / INDIVIDUAL ASSOCIATE (STUDENT) MEMBER Please complete and mail this form together with your payment to: Director of Membership Extension, GPO Box 6542, Hong Kong. Website : www.hkcii.org