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 2001, Tower 1, China Hong Kong City, 33 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33號中港城1座2001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. 閣下是否任何政治人士或與政治人士(“政客”)有聯繫？ （政治人士-目前或曾經託擔任重要公職的人士，例如國家/政府首長，資深政客，國有企業高級行政人員，重要政黨官員等）

   Are you a, or linked to any, politically exposed person/s (“PEP”)? (Politically exposed person – individual who is or has been entrusted with prominent public function. e.g. head of state/government, senior politician, senior executive of government-owned corporation, important political party official, etc)

   YES 是 NO 否
2. Name of PEP 政客姓名 *

   Position/Duties 職位/職責 *
   Name of Public Function 共職稱謂 *

   Country 國家 *
   PEP Relationship with Client 政客與客戶的關鯀 *

3. 閣下是否了解現居住國家已有法律或條例立以制止洗黑錢活動？

   Are you located in a country with established laws/regulations designed to prevent money laundering?

   YES 是 NO 否

4. 如上題（2）題的回答為“是”，則閣下是否了解您亦受此類法律/條例的管制?

   If the answer to (2) is YES, are you subject to such laws/regulations?

   YES 是 NO 否

5. 閣下是否就反洗黑錢條例或反恐怖分子籌資活動條例維持“無罪記錄”？ 如果否，請在另一張紙上提供詳細資料。

   Have you maintained a “no conviction record” for anti-money laundering or anti-terrorist financing legislation? if no, please provide details on a separate sheet.

   YES 是 NO 否