Year 2011 - Bancassurance – my perspective 銀行保險 我知我見

Type of Membership Applied (Please refer to the membership definition stated below before completion) Individual Member Individual Associate Member Individual Member (Entrance Fee: HK$50; Annual Subscription: HK$150) or Individual Associate Member (Entrance Fee: HK$50; Annual Subscription: HK$150) Name : Mr / Mrs / Miss : Name in Chinese (if any): Date of birth : Nationality : Passport / ID number : Name of company : Correspondence address : Tel : Fax : E-mail : I am a registered agent / authorised broker in compliance with the law of Hong Kong. I am a person whose business activities are closely related to the Insurance industry. I am a person whose studies full time on subjects related to Insurances or Financial services in education institution. Position Held : Experience in insurance field: since (year) : Insurance qualification (if any): ( )FCII ( )ACII ( )ANZIIF ( )FLMI ( )CLU Others: (please specify) : My main line of business : General / Life / Composite Insurance Others : My / Our membership fee made payable to Hong Kong Chamber of Insurance Intermediaries is herewith enclosed as follows : Bank name : Cheque number : Amount (HK$) : 200 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. For office use only Date received : Date ack. sent : Membership No. Assigned Date approved : Date cert. sent : Individual Membership due date : Ind. Associates Remarks : INDIVIDUAL MEMBER / INDIVIDUAL ASSOCIATE MEMBER Membership Application Form(B) I / We, the undersigned hereby apply for admission to become Individual Member / Individual Associate 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. Tel: 8108 1238 Fax: 8108 1282 GPO Box 6542, Hong Kong Email: admin@hkcii.org Website : www.hkcii.org