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Sinopec VIP Card Application Form HK Federation of Trade …

VIP Sinopec VIP Card Application Form ( For internal use only): HK Federation of Trade Union Diesel Vehicle FTU20140501S 3496. , . (Please complete this form in BLOCK LETTERS). FTU20140501F 3497. : FTU20140501V 3498. l l l l l l l l l l l l l l l l l Name: l l l l l l l l l l l l l l l ( 30 , Max. 30 characters). *: l l l l l l l l l l l l l l l l l l l l l Mailing l l l l l l l l l l l l l l l l l l l l l Address l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l *( Mailing Address must be same as address proof). : Contact Numbers: l l l l l l l l l l / l l l l l l l l l l l : Email: l l l l l l l l l l l l l l l l l l l l l : : Contact Person: l l l l l l l l l l l l 1. ( : ). 2. ( ! " #). ( ) 3. $ % & & ' ( ) * + & , - .. (Please to indicate type of fuel) Diesel Please return Application form with following copies: : 1. Address proof ( Electricity Bill). Vehicle No.: l l l l l l l l l l l 2. HK Vehicle Registration Document(s).

7. VIP Card shall at all times be the property of SINOPEC and must be surrendered to SINOPEC immediately upon request. SINOPEC may, at its sole discretion, terminate the membership, the Programme or VIP Card at any time without prior notice.

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Transcription of Sinopec VIP Card Application Form HK Federation of Trade …

1 VIP Sinopec VIP Card Application Form ( For internal use only): HK Federation of Trade Union Diesel Vehicle FTU20140501S 3496. , . (Please complete this form in BLOCK LETTERS). FTU20140501F 3497. : FTU20140501V 3498. l l l l l l l l l l l l l l l l l Name: l l l l l l l l l l l l l l l ( 30 , Max. 30 characters). *: l l l l l l l l l l l l l l l l l l l l l Mailing l l l l l l l l l l l l l l l l l l l l l Address l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l *( Mailing Address must be same as address proof). : Contact Numbers: l l l l l l l l l l / l l l l l l l l l l l : Email: l l l l l l l l l l l l l l l l l l l l l : : Contact Person: l l l l l l l l l l l l 1. ( : ). 2. ( ! " #). ( ) 3. $ % & & ' ( ) * + & , - .. (Please to indicate type of fuel) Diesel Please return Application form with following copies: : 1. Address proof ( Electricity Bill). Vehicle No.: l l l l l l l l l l l 2. HK Vehicle Registration Document(s).

2 3. Valid HK Federation Trade Unions membership l l l l l l l l l l l cards or member fee receipt copy. VIP ! " # $ , % & ' ( ) * VIP + , , - . / 0 1. 2. 3 4 5 6 7 ! " # $ 8 9 : ; < = > 3 ? @ , AB C ; D E 8F # 3 G. H ? @ (I J )! K L M N O P 8Q R ST VIP 8. Please read the Terms and Conditions carefully. By signing and submitting this Sinopec VIP Card Application Form, applicant shall constitute acceptance of the Sinopec VIP card discount offer and the Terms and Conditions. If you are not obliged to provide Sinopec with the above information, Sinopec may not be able to process your Application . Please also read the Policy Statement relating to the Personal Data (Privacy) Ordinance carefully. Thank you for choosing Sinopec VIP Card. / 0 1 2. 2 $ % & M N O P & ' Q R T . Stamped and verified by HK Applicant Signature: 3 4 $ & % 5 & . 6 7 8 9 : ; <=>? @ AB .. Federation Trade Unions: C D E F G H I J K L.. Please post the form with supporting document to: _____ _____.

3 HK Federation Trade Unions & ' AS 2 U V 2. 12, Ma Hang Chung Road, To Kwa Wan, KLN. Membership No.:_____ Application Date:_____. Application for Sinopec VIP card W T 0 1 X Y Z [ Consent to Use of Personal Information ( Z [ # Consent ). U V W X Y T Z L [ \] . ^_ ` 0 a b Ac d e f g Ah i[e j k l m /< = L n g Ah i[ /Ao p q k l m L n g Ah irsU V W t : u v . / w C ; 9x Y T H ? @ 8 t ^ y z ^ { \|- H S} ~' ( . / , 9 C U V W Y T H ? @ , G ^ y z ^ { \S. } C v ~' ( U . / 8. We/Our company intend to use your name, telephone number and address for direct marketing or promote fuel products or services, products and services offered in the convenience stores and/or filling stations but we cannot use your personal data without your consent. Please sign at the end of this Consent to indicate your agreement to such use. Should you find such use of your personal data not acceptable, please indicate your opt-out request before signing by ticking the appropriate check box below and sign at the end of this Consent.))]]]]

4 ? @ To: The Data Protection Officer ( )e j > V W. Sinopec (HONG KONG) PETROL FILLING STATION COMPANY LIMITED. 28377 \ P. O. Box No. 28377, Gloucester Road Post Office, Hong Kong Date _____. G y z ^ { \|- H S} * Please tick the appropriate check box below to indicate your choice*. /U Z > l L c d ? @ A , sC G 4 5 [f g [6 7 a b . We/I WISH to receive all of direct marketing materials or messages from the Company via all channels, including but not limited to discount upgrades, complimentary products, promotions and privileges. /U \ ] v V W ^ l L c d ? @ A . We/I DO NOT wish to receive any direct marketing materials or messages from the Company via the following channel(s): \ ] v - r < = _____. DO NOT wish to receive - Email, please provide e-mail address(es): \ ] v - r < = \] _____. DO NOT wish to receive - SMS and phone, please provide mobile phone number(s): \ ] v - r < = _____. DO NOT wish to receive Direct mail, please provide mailing address: *9 > t y y z ^ { \|- H S} , A , ^ y z { \s > < = # ?}

5 , < * A' ( U . / , _ . / U V W Y T H ? @ , ^ y l c d ? @ A 8. * If applicant does not indicate your choice by ticking any of the above check boxes, or ticking ALL of the above check boxes without providing details, by signing or submitting this Consent, applicant agrees our Company using your personal information for the issuance of direct marketing materials or promotion messages in any channel.. Customer Name: _____. > , < = \] Existing customers, please provide card number: \] : 01_____ VIP \] : 71_____. Sinopec Card Number VIP Card Number \] _____ t D E v . Contact Numbers (Note: will use as contact if it is necessary for the processing of the opt-out request.). ' (. Customer Signature _____. VIP. 1. VIP ( VIP ) . 2. ! " # $ VIP % & '( ) * + , - '. / + , 01 2 3 '+ , ! 4 5 6 VIP '7 8 9 : VIP 01 ; 8 '<. = $ > ! 2 ? VIP @ A B C D . 3. > ! E ( F G H I J K > L VIP . 4. VIP M N O P Q R KS N O TU; 8 . 5. > ! ( UV * W X Y K VIP 'VIP Z [ > ! ; 8 , VIP B KN O \ P ] ^ _ S !))))

6 6. VIP ` a b c de a f 8 , P Q ^ _ g ` h i j k l B P ] m n i j . 7. VIP o Up \ M q r 'o s t U'u v <4 VIP . w x y z K{ | } ~ F Up > ! M. ' VIP ' P ( s 6 I . 8. ; 8 VIP M u 2 I ' u M '` | > ! | . M 0 M b u M '| > ! . 9. F Up ' h ( > ! P Q I . 10. @ A B C D ? Y '` . 11. % & VIP d d ( 6 ' X 7 8 M ' 7 8 L x . P U . 12. > ! T ' VIP ' & 5 I J VIP U' % | K L B VIP J M '0. 1 > ! I J L VIP J L K L P ' X { > ! VIP G M s t T. U'> ! P Q | F VIP M ' X { 2 ? VIP . 13. > ! T ' VIP ' h ( L x < K G g VIP . $ L .. 14. > ! | I L ' ? L . 15. ~ '> ! o M 7 8 B . 16. X VIP + , M M . 17. > ! B X KF VIP + , - [ M 9 \ h d B '` VIP + , B K L ! " . E ( M > ! # 4 % + , B 0 VIP M ; 8 R $ > ! % ] [ + , M . 'D K+ , x ] P 5 ' & . M + , - B \ P 5 6 w > ! + , M X ' ( 7 ) ( * + , - M U )'. X ' ( . / ' % . 18. VIP '> ! ( v <0 1 2 3 4 5 (1 6 : 2495-3338) 7 '` 8 9 <; 6 : ~ '. > ! ; ( | VIP $ M .. 19. > ! . / M VIP < u = % & o > I H ? @ A . 20. > ! o + , U [ M B ! B C D E 'u v < 8 9 F 3 '.))))))))}}

7 21. > ! G x ; 8 K > L VIP o P UH M I J P U M K L B 2 3 > ! o I J M K L UE ( & I J. K VIP . $ ' & % VIP B f 8 ( N 8 ) T O . L z . > ! P a > ! o . Q R 30 S .. I T 'U D V > ! = 2 3 6 W M . X ~ Y h Z . 22. > ! ( F G [ $ '<U i j f 8 \ c ' x ] G . 23. > ! % ] F G H I J K > L VIP I J L M K L ' X { > ! [ VIP ^ L _ ` N O ' . ( 5 Q > ! L a T . 24. > ! T ' > ! ] ' 6 i b % $ A [ ' x ; 8 > ! F + , U X L B ! ( c d > ! e d1 6 . B ) > ! C f $ A [ L B g h . 25. o P i @ A B @ L KS @ L ~ ' h ( j k % ] l VIP B / m n do p n L q r s d F dt dS u do p X r Bv I w i x y L ~ z ? L { . 26. @ A BC D M | B } ~ T '0 . Terms & Conditions of Sinopec VIP Card 1. Sinopec VIP Card ("VIP Card") is the property of Sinopec (HONG KONG) PETROL FILLING STATION COMPANY LIMITED. ( Sinopec ). 2. Any Person desiring to become a VIP card member must complete and submit an Application in the form prescribed by Sinopec and shall be issued with a Sinopec VIP Card ( VIP Card ) at no charge. Use of VIP Card by VIP Cardholder shall constitute acceptance of the Sinopec VIP Card's terms and conditions.))))}

8 3. Cardholder must present the VIP Card prior to the fill up. 4. VIP Card cannot be used in conjunction with other discount or promotional offers. 5. Cardholder shall keep the VIP Card secure. VIP Card shall only and exclusively be used by VIP Cardholder and is not transferable. 6. VIP Card is not a charge card or credit card and is non-transferable. VIP Card contains no cash value and cannot be redeemed for cash. 7. VIP Card shall at all times be the property of Sinopec and must be surrendered to Sinopec immediately upon request. Sinopec may, at its sole discretion, terminate the membership, the Programme or VIP Card at any time without prior notice. 8. All offers are bound by the terms and conditions of Sinopec (Hong Kong) Petrol Filling Station Company Limited. In case of any disputes, the decision of Sinopec (Hong Kong) Petrol Filling Station Company Limited shall be final. 9. Sinopec reserves the right to withdraw or terminate the Programme at any time without prior notice.

9 10. These Terms and Conditions shall be governed by and construed in accordance with the laws of Hong Kong Special Administrative Region. 11. Sinopec reserves the right to impose on the Cardholder a fee of which Sinopec may fix from time to time for the issuance of a replacement card either as a result of the VIP Card being lost, stolen, disclosed or the alternation of purchase options. 12. Cardholder acknowledges that if vehicle number is embossed on VIP Card, Sinopec will verify the vehicle number against Cardholder's vehicle as VIP Card is presented to the Petrol Filling Station attendant. Once verified that Cardholder's droved vehicle number differs from that printed on VIP Card, Sinopec reserves the right NOT to accept fueling request by such VIP Card. At the same time, Cardholder cannot make any changes to information printed on VIP Card (by whatever means of in any form whatsoever). Sinopec reserves the right not to accept such VIP Card.

10 13. Cardholder acknowledges that if Vehicle Number is NOT printed on VIP Card, there's no need for Sinopec to verify driver's identity and can immediately proceed to the fueling process. Sinopec bears no obligations for transactions completed by such VIP Card. 14. If Cardholder acts fraudulently or with gross negligence against Sinopec , he/she shall be responsible for all losses incurred by Sinopec . 15. In case of default, Cardholder is liable to pay for ALL costs and expenses incurred by Sinopec in recovering the debt. 16. Sinopec reserves the right to destroy any documents relating to VIP Card applications. 17. Cardholder declares that all information given in the VIP Application form is true, accurate and complete, and is required for and relied upon for the purpose of VIP Application processing, and for future account operation. Cardholder understands their provided information will be used and relied upon by Sinopec for purposes of VIP Card Application and all matters relating to VIP Card Program.


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