第1页共2页编号：时间：2021年x月x日书山有路勤为径，学海无涯苦作舟页码：第1页共2页TheHongKongConfederationofInsuranceBrokers香港保險顧問聯會AMENDMENTFORMFORCHIEFEXECUTIVEREGISTRATION行政總裁註冊資料更改表ForOfficeUseOnlyChequeNo.VerifiedByPaymentClearedCurrentParticularsofApplicant申請人資料OfficeUseNameinEnglish英文姓名Surname姓氏Othername名字HKIDCardNo.身份證號碼Reg.No.註冊號碼CompanyName公司名稱Mem.No.會員編號TypesofAmendment更改類別(Pleaseprovideuswithrelevantsupportingdocument請提供相關證明文件)A.ChangeofLineofBusiness(Adding/Deleting)更改業務類別(增加／減少)(Pleaseticktheline(s)ofbusinessyouwanttoapplyfor,includingthelineofbusinessalreadyregisteredandyouwillmaintain.請揀選申請的業務類別，包括已註冊而需保留的。)(SubjecttofeeperFeeScheduleItems5(foraddition)&6(fordeletion).所需費用見費用表第5(新增)及6(取消)項)From由To改為GeneralInsuranceOnly(‘GI”)只限一般保險GeneralInsuranceOnly(“GI”)只限一般保險LongTerm(excludinglinkedlongterm)InsuranceOnly(“LX”)只限長期保險(不包括相連長期保險)LongTerm(excludinglinkedlongterm)InsuranceOnly(“LX”)只限長期保險(不包括相連長期保險)LongTerm(includinglinkedlongterm)InsuranceOnly(“LI”)只限長期保險(包括相連長期保險)LongTerm(includinglinkedlongterm)InsuranceOnly(“LI”)只限長期保險(包括相連長期保險)GeneralandLongTerm(excludinglinkedlongterm)Insurance一般保險及長期保險(不包括相連長期保險)GeneralandLongTerm(excludinglinkedlongterm)Insurance一般保險及長期保險(不包括相連長期保險)GeneralandLongTerm(includinglinkedlongterm)Insurance一般保險及長期保險(包括相連長期保險)GeneralandLongTerm(includinglinkedlongterm)Insurance一般保險及長期保險(包括相連長期保險)ConfirmationfromInsurers承保人確認(Applicableforaddingnewlineofbusiness適用於新增業務類別)LettersfromthefollowinginsurersareattachedtoconfirmthattheyagreetotransactbusinesswiththeMemberwhentheApplicantisregisteredfortherespectivelineofbusinessappliedtobeadded.Thelettersaredulysignedontheinsurers’letterheadbyexecutivesatamanagementlevelwithintheinsurersconcerned.附下述保險公司信件，確認當申請人新增相關業務類別，同意與該公司展開業務Namesoftheinsurers保險公司名稱GL1.2.3.4.5.Thefollowingtwotypesofamendment,subjecttofeeperFeeScheduleItem6以下兩項更改類別所需費用見費用表第6項B.ChangeofNameofRegisteredPerson更改申請人姓名C.ChangeofCapacityfromChiefExecutivetoTechnicalRepresentative更改註冊類別由行政總裁改為業務代表第2页共2页第1页共2页编号：时间：2021年x月x日书山有路勤为径，学海无涯苦作舟页码：第2页共2页IhaveverifiedtheaboveinformationandundertaketoinformCIBofanysubsequentchanges.本人已核實上述資料並承諾如上述資料有所更改,會通知聯會。Iherebyconfirmtheaboveinformationprovidedistrueandaccurate.本人在此確認上述資料真實及正確無誤。AuthorizedSignature(otherthantheapplicant)andCompanyChop簽署(除行政總裁外)及公司蓋章SignatureofApplicant申請人簽署NameofSignatory簽署人姓名Date日期//Date日期//
