三三金融預付卡申請表

Declaration 聲明

I understand and hereby agree that my Identity Card / Passport copy and other relevant personal information will be used by 33 Financial Services Limited ("33 Finance") for the application of 33 Finance Prepaid Card. I further agree that 33 Finance may use and disclose my personal data that 33 Finance holds for the purposes as set out in the Privacy Policy Statement of 33 Finance stated in www.33finance.com.

本人明白及同意，以及所提供的個人資料、會被三三金融服務有限公司(“三三金融”)用作處理三三金融預付卡申請之用途。本人亦同 意三三金融可根據載於 www.33finance.com的三三金融私隱政策聲明中所述的目的， 而使用及披露三三金融所持有有關本人的個人資料。

The source of money is legitimate and I understand that 33 Finance may disclose all data relating to the card to all authorities for the purpose of investigation under the laws of Hong Kong SAR.

此卡資金來源是合法取得，本人明白三三金融可能會根據香港特別行政區法律向所有當局披露與該卡有關的全部資料。

I have read and agreed to be bound by the 33 Finance Prepaid Card Terms & Conditions as stated in www.33finance.com.

本人已閱讀並確認已清楚明白上載於網上(網站www.33finance.com)之三三金融預付卡條款及細則，並承諾履行各項規定。

I understand 33 Finance may not accept the Prepaid Card application in view of individual applicant’s circumstances.

本人明白三三金融有權根據本人之個別情況拒絕接納預付卡之申請。

I understand that 33 Finance may, at anytime and without giving any prior notice, terminate or suspend my account(s) if I am or shall be in breach of the declaration and/or undertaking above, and 33 Finance shall not be liable for any of my loss or claim in connection with or arising from such breach.

本人明白，若本人違反或將違反以上聲明和/或承諾，則三三金融可以隨時不經任何事先通知而終止或暫停本人帳戶。三三金融恕不負責 由此涉及的任何損失或與前述違反有關或由前述違反而引起的任何申索。

I confirm that all information in this application is true, correct and complete.

本人確認以上各項填報資料均屬真實、正確及完整。

Opt-out from Use of Personal Data in Direct Marketing 選擇拒絕在直接促銷中使用個人資料

33 Financial Services Limited ("33 Finance") may, with your consent, use the Personal Data in this application including your contact information for the purpose of informing you about 33 Finance's latest products and services, promotional offers and other marketing information. You consent to be contacted for such purposes unless you opt out of receiving such information. Please tick "✓" in the box below if you do not wish 33 Finance to use your personal data for direct marketing.

三三金融服務有限公司("三三金融")經您同意的情況下可能會使用您的個人資料，包括您的聯繫方式與您聯繫，通知您三三金融最新的產 品和服務，促銷優惠和其他市場信息。若您不希望三三金融在直接促銷中使用您的個人資料，請在下列空格內劃上「✓」號。

I do not agree to the use of my personal data for direct marketing. 本人不同意使用本人的個人資料作直接促銷。

The Above represents your present choice regarding whether or not to receive direct marketing materials. This shall replace any choice you might have given to 33 Finance prior to this application.

以上代表閣下現在接收直銷推廣資料的決定。這取代您在本申請前可能曾給予三三金融的任何選擇。

Request for accessing or correction of personal data or any enquiry about using data for marketing activities can be made in writing to

enquiry@33finance.com or sending us a letter to 33 Financial Services Limited:

Suite 710, 7th Floor, Ocean Centre, Harbour City, 5 Canton Road, Tsim Sha Tsui, Kowloon, Hong Kong.

要求查閱或更改個人資料或查詢任何有關使用個人資料直接促銷可發送郵件到enquiry@33finance.com 或郵寄到:

香港九龍尖沙咀廣東道5號海港城海洋中心7樓710室 三三金融服務有限公司

防止洗黑錢及防止恐怖分子籌資活動問卷

ANTI-MONEY LAUNDERING AND ANTI-TERRORIST FINANCING QUESTIONNAIRE

1. Are you a, or connected to any politically exposed person(s) ("PEP")?

   閣下是否屬政治人物或與政治人物有聯繫？

   PEP - Individual who is or has been entrusted with prominent public function, e.g. head of state/government, senior politician, senior government, judicial or military officials, senior executive of state-owned corporation, important political party official, etc.

   政治人物 - 目前或曾經擔任重要公職的人士，例如國家/政府首長、資深政客、政府\司法或軍事高階官員、國有企業高級行政人員、重要政黨幹事等

   YES 是 NO 否
2. Name of PEP 政治人物名稱 *

   Position/Duties 職位/職責 *
   Name of Public Function 職能單位 *

   Country of Position 職位所在國家 *

   PEP status 政治人物狀態 * Please Select 請選擇 在任(Current) 曾任(Former)

   year ceased to hold the public position 不再擔任公職之年份 *

   PEP relationship with Client 政治人物客戶的關係 * Please Select 請選擇 本人(Self) 關係密切的人(Close Associate) 配偶\伴侶\子女\父母\子女的配偶或伴侶(Spouse/partner/child/parent/ spouse or partner of child) 其他：請註明(Other：Please Specify)
   Other PEP Relationship with Client 其他政客與客戶的關鯀 *

3. 閣下是否曾在香港/其他地方因任何犯罪活動或違規被檢控及定罪,包括但不限於洗黒錢和恐怖份子籌集資金?

   Have you ever been charged and convicted of any criminal activities and requlatory violation, including but not limited to, money laundering and terrorist financing,in Hong Kong/elsewhere?

   YES 是 NO 否
4. Details of offence 罪行詳情 *
   Date of conviction 定罪日期 *
   Sentence 判刑 *