声明中文翻译仅供参考中英文若有不符之处以英文为准

汽车防撞系统

TIME DEPOSIT ACCOUNT APPLICATION FORM DECEMBER 2016 VERSION 1.0

TIME DEPOSIT ACCOUNT APPLICATION FORM 个人定期账户申请表（中文仅供参考，请用英文填写）

Please use black ink and BLOCK CAPITALS to fill in your details below. It is important that you complete this application form in full and sign as required to enable us to consider your application. Although, you are our

existing customer we require you to provide proof of who you are for the purpose of compliance with Anti-Money Laundering Requiremen ts and the Bank’s own risk management procedures. 请用黑、大写字母填写以下表格。完整的信息提供和确认签字是我们考虑账户申请的基础。尽管您的个人账户已开通，您仍遵循照反及银行自身风险管理流程的规定提供身份证明。

Are you OK to provide the Bank with your current identification documentation? 您是否可以提供有效身份证明文件？ □YES 是 □ NO 否

里氏木霉If Yes, please continue to complete your application in English and If No, we are unable to process your request to open a Time Deposit Account with ICBC (London) Plc.

如果是，请继续以英文填写以下申请表格；如果以下表格中的信息提供不完整，我们将无法处理您的定期账户开立申请。

Disclaimer: The Chinese is for information only and not an official translation and under any dispute the English will prevail.

声明：中文翻译仅供参考，中英文若有不符之处以英文为准。

APPLICANT 申请人

Personal Details 个人资料

数量单位

Title (Mr, Mrs, Miss, Ms)

谢冰莹称谓（先生/夫人/小/女士）___________________

Surname 姓____________________________________

First name(s) 名字___________________________

Date of birth (DD/MM/YY)

出生日期（日/月/年）__________________________

Existing Account (s) with ICBC (London) plc

Flexible Account No.（账号___________________

If you have more than one flexible account, please provide details below:

Flexible Account No .（账号______________________ Contact Details

Home Tel. No.家庭座机_______________________

Mobile No.手机号码_________________________

Email address 地址___________________

Instructions 指令

Fixed Deposit Instructions (please tick ) 定期存款指令（请勾选）

Over the counter 柜面 □ Online*网上银行* □

* this is subject to you having online banking 取决于是否有网银功能

Declaration声明– please tick each statement below, confirming you have read and understood: 请确认阅读并理解以下声明并勾选：

经济问题探索APPLICANT SIGNATURE申请人签名2019十大经济年度人物

Your signature您的签名________________________________________________________________________ Date of signature (DD/MM/YYYY) 签署日期（日/ 月/ 年）

___________________________________________________________________________________________

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