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9OTF gtX1. Please complete in /LODK 7FTTFRS and tick where applicable. _4`ujN>[=.

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2. * For NIL Balance Investment Statement request, please speciIy in the option 'Others'.
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To b?IF 5ONHKONH BNE >IBNHIBJ /BNKJNH 0ORPORBTJON 7JMJTFE
Date
month year
*|
+ C day *
/ /
O
P
S
0
8
1
R
1
6
-
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(
2
9
1
2
1
1
)
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W
(
1
6
0
1
1
2
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3OR /BNK @SF :NLV {ema
3OR 6TFM=FLBTJNH TO .DTJONS =FQUJRFE
For interim statement (ie Ior transactions perIormed between the last statement date and the day
beIore the request), submit this Iorm to 4>0 via NSC.
For statement period on or beIore the last statement date, input via Central Retrieval System (CRS).
Authorised Signature and Branch Chop
For interim statement and Debit Interest Statement requests, submit this Iorm to 4>0 via NSC.
For statement request oI other cycles, input via Central Retrieval System (CRS).
Input via Central Retrieval System (CRS).
Current Account /
Super Ease Account /
Investment Account
IA/ BIAAccount
Savings Account /
Paid Cheque Copy
# Please speciIy Savings/Current Ior Integrated and Business
Integrated Account. ?`<uosq<)]_Y_],VP
5BNELJNH 0IBRHF (as stated in the General Bank TariIIs)
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(Not applicable to Debit Interest Statement request
Please debit my/our #account number
:
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>JHNBTURF+S, BNE 0ONTBDT ?FLFPIONF 9UMCFR v[Qrzxw|
Signature(s) }}
X
Remarks x
S.V.
Contact Telephone Number __Q
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1FTBJLS OG .DDOUNT \Zyj
Account Name )]; Account Number (Not applicable to Certificate
of Balance) )]Q4WA}g_Yj(
S
T
P
(
E
M
C
)
Period i| From 5 to G
(Onlv the two most recent Debit Interest Cvcles are available
1FTBJLS OG =FQUFST b}yj
Please arrange to supply me/us with a copy oI the Iollowing document(s) and mail them to my/our correspondence address:
__2(9_8[p2NtV2([wn=J
* Statement/Report * z,aj
Account Statement )]z
Debit Interest Statement ^Igz
(For Integratea ana Business Integratea Account onlv
Paid Cheque jv
Transaction Date 7X*|
Others R-
Savings Bank History Report _]A}Ejaj
Savings Consolidation Statement _]A}<z Statement Date z*|
Period i| From 5 to G
Credit Card Statement ^4/z
Cheque Number jvQ Cheque Amount jv]Q
1l{Oy\QeU|[^Igz) 14W<uosq<)])
CertiIicate oI Balance A}g_Yj
Please Iurnish me/us with a CertiIicate oI Balance as at the close business on
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Ior the Iollowing accounts:
M]qi[A}g_Yj
Period i| From 5 to G
Braille Account Statement Services (Applicable to HKD Current Account, Integratea Account - HSBC Premier/HSBC Aavance onlv)
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Add }q
Account Number )]Q
EIIective Date 3h*|
Delete Tk
Account Number )]Q
EIIective Date 3h*|
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Statement Date z*| (MM/YY +,C)
From 5 to G
>> SFS-NSC / CPD
9OTF gtX II customer requests a re-printing copy oI Braille account statement, the Bank can only provide customer with the re-printing copy oI
statement in written Iormat. ?_)cd:@z2H10{O,_BKDd:z_)