申請表格The Hong Kong Institute of Directors.doc

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1、Membership Application Form會員申請表格 * Entrance入會 * Upgrade升級 * Data Change 更新資料(Please refer to the Notes on Application請參閱會員申請細則)2104 Shanghai Industrial Investment Building, 48 Hennessy Road, Wan Chai, Hong Kong l 香港灣仔軒尼詩道48號上海實業大廈2104Tel電話: (852) 2889 9986 Fax傳真: (852) 2889 9982 E-mail電郵: executive

2、 Web-site網頁: Membership Grade Applied For申請會員級別: r Fellow資深會員 r Member 會員 r Associate附屬會員r Affiliate 連繫會員(Office Use請勿填寫)Section 1: Personal Particulars 個人資料 Data items marked by “#” in this section will be included in the Membership Directory. 此部份內註有#號的資料將被錄入會員名冊。# Mr / Mrs / Miss / Ms / Dr / Prof

3、/ Ir /英文稱號# Name in Chinese中文姓名Sex性別# Honours/Designations after Name姓名後名銜Surname 英文姓氏 Forenames英文名字# Format of Name in Correspondence函件上採用的英文姓名格式Date of Birth出生日期(day/mth/yr日/月/年)HK ID Card No. 香港身份證號碼Nationality國籍Business, Professional & Academic Qualifications學歷、履歷、專業資格Company Address公司英文地址Tel電話:

4、 Fax傳真:Home Address住宅英文地址Tel電話: Fax傳真:Email電郵Correspondence Address, Tel, Fax聯絡地址電話傳真: r Company 公司 r Home住宅Section 2: Work and Director Experiences 工作年資及董事經驗Applicants Experience申請人年資: Total Work Experience全部工作經驗 Years年 Director / Equivalent Experience董事或相約職務經驗 Years年. List of major directorships,

5、current and past, continued on separate sheet if necessary. 現在及過去主要董事職務列舉，可另頁續寫。From由To至Company Name公司名稱Position held職位Section 3: Profile Of Current Principal Company 現時所屬主要公司資料Name of Current Principal Company in English and Chinese現時所屬主要公司英文及中文名稱Co Legal Status 公司法律地位(Code代號*)# Position in English

6、 and Chinese職位英文及中文名稱Company Main Activity (in 30 English characters maximum including spaces) 公司主要業務(以最多15中文字簡述)No. of Board Members公司董事人數r 10No. of Employees公司僱員人數r 1-10 r 11-50 r 51-100 r 101-500 r 501-1,000 r 1,000* A. Listed co上市公司; B. Private limited co私人有限公司; C. Partnership合夥企業; D. Subsidiary

7、 of overseas co海外機構之附屬公司;E. Sole proprietorship獨資經營; F. Government政府; G. Statutory or public or not-for-profit co法定或公營或非牟利組織; H. Others其他.Membership Application Form會員申請表格 Applicants Name申請人姓名:Section 4: Corporate Scheme / Group Organisation Offer公司計劃集體優惠Please insert a “” if applicable. 請以“”選擇r Cor

8、porate Scheme公司計劃 r Group / Organisation Offer集體優惠Corporate / Group or Organisation Name 公司/組別或組織名稱:Contact Person & Tel 聯絡人及電話號碼Section 5: Declaration宣言(a)I hereby apply for membership of The Hong Kong Institute of Directors and agree to be bound by the Institutes本人現申請成為香港董事學會之會員，並同意遵守學會之:-(i) Memo

9、randum and Articles of Association and 組織大綱與章程及(ii)Membership Accreditation Scheme, which includes a Code of Conduct and fulfillment of annual Continuing Professional Development.會員評鑒制度，此制度包含遵從行為守則及履行每年持續專業進修。Details from詳情載於 (b)I confirm that I have not been disqualified by Court Order from being a

10、 director. 本人確認不曾被法庭取消擔任董事資格。(c)I have read and understand the following declaration regarding personal data collection:- 本人已閱讀並明白下列有關個人資料蒐集的宣言：“The Hong Kong Institute of Directors has adopted a Personal Data (Privacy) Policy, full details of which are downloadable from Data subjects have a right o

11、f access and correction regarding their respective personal data. Data subjects who do not wish to receive communications may notify the Institute in writing. Requests can be directed to the Institute by post at 2104 Shanghai Industrial Investment Building, 48 Hennessy Road, Wan Chai, Hong Kong, or

12、by email at personaldata, or by fax at +852 2889 9982. For inquiries, telephone +852 2889 9986. Personal data collected by this document will be used to process application for membership and facilitate communications by post, email, telephone and fax.” 香港董事學會訂定個人資料（私隱）政策，其詳細內容可從網頁下載。資料當事人有權查閱及更正其相關

13、個人資料。資料當事人如擬停止收取通訊，可以書面方式向學會提出，郵寄香港灣仔軒尼詩道48號上海實業大廈2104、或電郵至personaldata、或傳真至+852 2889 9982。查詢電話+852 2889 9986此表格蒐集個人資料的目的為處理入會申請，並提供聯絡資料以透過郵遞、電郵、電話、傳真通訊。(d)I understand and accept the intention of The Hong Kong Institute of Directors to regularly communicate with me on updates, events, projects, mem

14、bership, services and publications. I understand that I may exercise the following option by inserting in the box:- 本人明白及接受香港董事學會定期通知我有關學會的最新資訊、活動、項目、會籍事宜、服務及刊物通訊，也明白本人可以在方格內加上” ”號選擇如下： r I DO NOT wish to receive above communications from the Institute. 本人不願意接收學會的以上資訊。(e)I understand that upon admis

15、sion to membership, the Institute will include my name, company and position on its Welcome List emailed to members and will include my name in the Membership Directory in the Members Login Area of the Institutes website. I indicate by my options as follows:-本人理解當我加入會籍後，學會將以電郵方式傳閱歡迎名單，當中包含我的姓名、公司及職稱

16、，並刊登我的姓名於會員登入網頁部份內的會員名冊。我以選擇：r I opt to be EXCLUDED from the Welcome List. 我不願意被列入歡迎名單中。r I opt to be EXCLUDED from the Membership Directory.我不願意被列入會員名冊。Signature簽名: Date日期: Section 6: Sponsor 推薦人 (to be completed by the Sponsor 由推薦人填寫)Sponsor Name推薦人姓名:Tel電話:Fax傳真:I, being HKIoD member, hereby prop

17、ose the applicant. 本人現時乃香港董事學會之會員，特推薦上述申請人。Signature簽名: Date日期: Section 7: Completion of Application Form 完成申請表格Please check and items enclosed. 請下列各項。.rA photograph with name at the back (no glue or staples). 相片一幀背面書寫姓名但請勿用黏膠或書釘。rA crossed cheque for One-time Registration Fee and First-Year Subscription Fee. 劃線支票，預付整筆過登記費及首年年費Payable支票抬頭人: “The Hong Kong Institute of Directors Ltd” .Note: Unsuccessful applicants will be refunded with no interest payable. 註：如申請不獲接納將獲退款，惟不獲支付利息。rA business card. 名片一幀。