Global Cash Card Real Name Application Form 全球付卡實名申請表

A. Applicant 申請人資料 (Filled by cardholder 以下由持卡人填寫)

Chinese Name 中文姓名 N/A English Name 英文姓名/拼音
ID Card/Passport No. Expiry Date 證件有效期
身分證/護照號碼 (YYYY-MM-DD) (年/月/日)
Profession/Industry Nationality 國籍
Position 職位
(Country code) Mobile phone number Date of Birth 出生日期
(國際區號)手機號碼 (YYYY-MM-DD) (年/月/日)
Email address 電郵
Residential Address 住址
 For HKID Holder, please fill “Date of issue” on HKID 香港身份證持有人只需填寫證件簽發日期
B. Application items 申請事項及資料 (Filled by cardholder 以下由持卡人填寫)
Authorize an agent or authorized person of the company to apply for the global cash card on my Yes (Please fill Part C) 是 (請填 C 部)
behalf? No 否
是否由代理人或代辦公司的授權人為本人代辦申請全球付卡?
Purpose of opening account Shopping 消費購物 Payroll or commission 薪金/獎金發放和提取 Personal purchase 私人代購 Business purchase 商
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開戶目的 業代購 Daily consumption 日常小額消費 Personal loan payment 繳付私人財務欠款 Business loan payment 繳付商業
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財務欠款 Payment for friends 繳付朋友之間的帳單費用 Business payment 繳付商務之間的帳單費用 Personal fund
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allocation 個人資金調配 Business fund allocation 商務資金調配 Others 其他: ________________________

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#Global Cash Card Identity-Authenticated 實名認證 Card no. 卡號
申請全球付卡
Identity-Authenticated 實名認證 Card no. 卡號
Gift Card 禮品卡 HKD USD Amount*金額*
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CNY
 Please refer to Fee Schedule for the fees and charges 相關手續費請參閱全球付收費表
 The amount of card purchase shall not exceed HKD 25000 per time 每次購卡的金額不能多於 HKD 25000
C. Declaration of Authorization 授權聲明書 (Applicable for authorizing an agent or authorized person only 只適用於授權代辦)
I hereby consent to the following agent or authorized person of the company to apply for the global cash card on my behalf. The details of the agent / authorized person
of the company are as follows:
本人同意以下代理人或代辦公司的授權人為本人代辦申請全球付卡，授權人或代辦公司資料如下：

Agent Information 授權人資料

Name of agent or authorized person 代理人或授權人姓名

Company name of agent 代辦公司名稱
COI no. of agent 代辦公司營業執照號碼
If the agent is a company, please fill in all the above blanks 如代辦人為公司需填寫上述所有空格
* The information on this form must be consistent with the information on the identity document and a copy must be provided. *需與證件上的資料一致及需提供證件副本
D. Declaration by Applicant 申請人簽署及聲明 (Filled by cardholder 以下由持
卡人填寫)
I (The Applicant) hereby declare that after signing in the signature column herein below by myself (the Applicant), indicated that I have already fully read, understood, agreed,
confirmed and accepted:
本人 (申請人)謹此聲明，當本人於下列簽署欄內簽署後，即表示本人已細閱、同意、明白、確認及遵守以下各項聲明：
 The information provided in this Application Form is in all respects complete, true and accurate, and I should provide supporting documents and other information as
required by ePaylinks Technology Co., Limited (ePaylinks). I shall bear the legal responsibility for the above information;
本人確認本申請表格上提供的所有資料均為完整、真實及準確，及同意隨時提供相關證明、文件及其他補充資料；如有不實之處，本人願意承擔由此導致的
法律責任；
 I agree and authorize ePaylinks to review the accuracy and authenticity of all information on this Application Form, and ePaylinks shall have full power to accept the
application.
本人同意及授權全球付技術有限公司查詢、檢查及審核填寫在此申請表上的所有資料及申請事項，並同意全球付技術有限公司持最終審批權；
 I have read, understood and agreed to be bound by all clauses of 《ePaylinks – Terms and Conditions》, charges, limits and Privacy Policy as issued and announced in the
website of ePaylinks (www.globalcash.hk);
本人已閱讀、明白及同意發佈于全球付技術有限公司的官方網站 (www.globalcash.hk) 並不時修改的《全球付之條款及細則》、限額、收費及私隱政策，並同
意.
接受其約束。
 I agree and understand that my personal data will be collected by my agent or Authorized Person of The Company for the purpose of opening a global account.
本人同意及明白代理人或代辦公司會收集本人的個人資料用作開立全球付帳戶。
Signature 申請人簽署 Date 申請日期

E. Declaration of Witness by ePaylinks or ePaylinks Business Partners 全球付或全球付合作方見證聲明

(Applicable to witnessed ePaylinks Business Partners ONLY 僅適用於由全球付合作方見證)
I, the undersigned, am authorized by ePaylinks to verify the documents and information provided by the applicant. I have witnessed the signature and inspected the original
identity document of the applicant and certify that the copies of all documents provided by the applicant are valid and complete. 本人獲授權見證全球付卡業務申請。本
人已見證及驗證上述持卡人之簽署及有關其身份證明文件之正本均為有效及完整。
Name of witness 見證人姓名 Signature of witness and company chop 見證人簽署及公司蓋章*
 Business Partners must stamp a company chop 合作方須加蓋公司蓋章
Date 日期