ATM Card/Business Debit Card Services Amendment Form自動櫃員機卡／商業扣賬卡服務更改表格

Note 注意：1. Please tick where applicable. 請在適當的地方加上剔號。2. Information with shading must be completed. 陰影部分的資料必須填寫。3. Your request will normally be processed within 4 working days (excluding Saturday, Sunday

and public holiday) upon receipt of your form. 在一般情況下，本行將在收到您的申請表後四個工作天內（不包括星期六、日及公衆假期）處理您的申請。

Date日期 D D M M Y Y Y Y

Type of Application and Details 申請類別及有關資料

Card Number 卡號碼

Card Issue Number 發卡編號

Company’s Name (in Block Letters) 公司名稱（用正楷填寫）

(For Business ATM/Debit Card) （適用於商業自動櫃員機卡／扣賬卡）

Cardholder’s Full Name (in Block Letters) 持卡人全名（用正楷填寫）

Cardholder’s ID Details 持卡人身分證明文件資料

Type 種類

(I) Hong Kong Identity Card 香港身分證

(P) Passport 護照 (X) Other 其他

Number 號碼：

Contact Telephone No. 聯絡電話號碼

A. Card Replacement 補發新卡

Reason for Replacement 補發新卡原因

(D) Existing Card damaged or bent 原卡損壞或彎曲 (V) To replace HSBC Premier ATM Card (with old card retained) 更換卓越理財提款卡（保留舊卡）

(M) Chip/Magnetic Stripe malfunction when purchasing 簽賬時晶片／磁帶失效

(L) Reported loss of existing card 原卡已報失

(A) ATM message indicates that existing card does not work 自動櫃員機顯示原卡失效

(O) Others (please give details) 其他原因 （請詳細說明）▼

Note 注意：New Card will be mailed to your correspondence address. 新卡將會寄往閣下的通訊地址。

B. Card Cancellation 取消卡

Reason for Cancellation 取消原因

(A) Account is/will be added to another card with the Bank 戶口已／將附加於其他開立於貴行的卡內

(B) Not satisfied with the Bank’s Automated Teller Machine service 不滿意貴行的自動櫃員機服務

(C) Transfer account to other bank 轉用其他銀行的服務

(D) No annual fee waiver 須付年費

(E) Not required 不需要

(Z) Others (please specify) 其他原因 （請說明）▼

C. Hong Kong Jockey Club Cash Voucher Purchase Facility 購買香港賽馬會現金券便利

Hong Kong Jockey Club Cash Voucher Purchase Facility 購買香港賽馬會現金券便利

Required 需要 Not Required 不需要

Note 注意： The Hong Kong Jockey Club Cash Voucher Purchase Facility is an EPS debit facility and is subject to the EPS daily transaction limit, which is published from time to time in the ATM card User’s Guide. 購買香港賽馬會現金券須透過「易辦事」電子轉賬服務進行，故受到每日交易限額的限制，該限額已刊登於自動櫃員機卡使用手冊，本行並有權隨時更改。

Signature/Authorised Signature (For Business Account Only) 簽署／授權簽署（商業戶口專用）

For Bank Use Only 銀行專用Replacement Card Charges (for Card Replacement)

Yes (Y) No (W)

ID Checked or Signature Verified Initial:

Correspondence Address Checked (for Card Replacement)

Branch Chop and Authorised Signature

Card collection Branch Number Signature Number

Staff ID ATM

114R

15-m

(260815)

FW

>> ASV-NSCThe Hongkong and Shanghai Banking Corporation Limited 香港上海滙豐銀行有限公司