LUAHK

LUAHK MEMBERSHIP APPLICATION FORM

Subscription year*

Job Nature*

Position*

Insurance Agent License No

Highest Education

Professional

Date of entry into life insurance business

Personal Particulars*

Family Name*

Given Name*

Name in Chinese

Date of Birth*

ID No.*

Nationality*

Home Address

Flat

Floor

Building

Street

District

Country

Mobile*

Other Contact

Email Address*

Referee Name

Referee Tel

Proposer

Seconder

Company

Company Name*

Other Company Name*

Company Address

Flat*

Floor*

Building*

Street*

District*

Country*

Company Staff Code

Office Tel

Office Fax

Member Declare

I declare that I am primarily engaged in the business of life insurance and that I wish to become an Associate / Provisional / Senior member of The Life Underwriters Association of Hong Kong Ltd.and that if elected. I agree to subscribe to the following Membership Pledge.

Membership Pledge

As a member of The Life Underwriters Association of Hong Kong Ltd., I pledge that I will always PLACE the interests of policyowners and prospective purchasers before those of any insurer of myself; AINTAIN the higest standards of professional competence in order to advise policyowners and prospective purchasers to the best of my ability; RESPECT the confidence of policyowners and prospective purchases ans carefully guard any information which becomes known to me regarding their personal and business affairs; UPHOLD the best interests of the institution of life insurance; and COMPLY with the Memorandum and Articles of Association, By-laws, and Code of Ethics of The Life Underwriters Association of Hong Kong Ltd.

*your company address will be your correspondence address.

Annual Membership is valid untill December 31 every year.

I understand that the information provided will become my record and may be used for all purposes relating to membership application, record keeping and all activities related to LUAHK. I also agree and accept that all photos and videos taken during my participation in LUAHK events would be used for publications. I understand and accept that the paid membership fee is non-refundable and non-transferable.

Address:Unit A-D, 23/F., Seabright Plaza, 9-23 Shell Street, North Point, Hong Kong

Tel：(852)2570 2256

Fax：(852)2570 1525

Email：info@luahk.org

Website：www.luahk.org