Membership Application Form Entrance 入會Upgrade 升級 Membership Grade Applied For 申請會員級別 Fellow 資深會員Member 會員Associate Member 附屬會員Affiliate Member 連繫會員 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 / Ir / 英文稱號 MrMrsMissMsDrProfIr # Name in Chinese 中文姓名 # Honours/Designations after Name 姓名後名銜 Sex 性別MaleFemale 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 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 Email 電郵 Company Address 公司英文地址 Tel 電話 Fax 傳真 Home Address 住宅英文地址 Tel 電話 Fax 傳真 Correspondence Address, Tel, Fax 聯絡地址電話傳真Company 公司Home 住宅 Section 2: Work and Board Director Experiences 工作年資及董事會成員經驗 Applicant’s Experience 申請人年資: Total Work Experience 全部工作經驗 (Years年) Board Director / Equivalent Experience 董事會成員或相約職務經驗 (Years年) List of major directorships, current, and past. 現在及過去主要董事職務列舉。 #1From 由 To 至 Company Name 公司名稱 Position held 職位 #2 #3 #4 #5 #6 #7 #8 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**)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 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 Other Legal Status No. of Board Members 公司董事人數<55-10>10 No. of Employees 公司僱員人數1-1011-5051-100101-500501-1,000>1,000 # Position in English 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) Section 4: Corporate Scheme in Enrolment / Group Organisation Offer 公司集體入會優惠/集團優惠 Corporate Scheme 公司計劃Group / Organisation Offer 集體優惠No Corporate / Group Name 公司/組別名稱 Contact Person & Tel 聯絡人及電話號碼 Organisation Name 組織名稱 Contact Person & Tel 聯絡人及電話號碼 Section 5: Declaration 宣言 1. I hereby apply for membership of The Hong Kong Institute of Directors and agree to be bound by the Institute’s 本人現申請成為香港董事學會之會員,並同意遵守學會之:- (a) Articles of Association and 《公司章程細則》及 (b) 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http://hkiod.com/accreditation.html. 2. I confirm that I have not been disqualified by Court Order from being a director. 本人確認不曾被法庭取消擔任董事資格。 3. 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 http://www.hkiod.com/statement.html. Data subjects have a right of 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 by email at personaldata@hkiod.com, or by fax at +852 2889 9982. For inquiries, telephone +852 2889 9986. Personal data collected by this document will be used to process applications 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 http://www.hkiod.com/chn/statement.html 網頁下載。資料當事人有權查閱及更正其相關個人資料。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@hkiod.com、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。」 4. I understand and accept the intention of The Hong Kong Institute of Directors to regularly communicate with me on updates, events, projects, membership, 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: I DO wish to receive above communications from the Institute. 本人願意接收學會的以上資訊。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。 5. I understand that upon admission 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 Institute’s 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,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:- I opt to be INCLUDED from the Welcome List. 我願意被列入《歡迎名單》中。I opt to be EXCLUDED from the Welcome List. 我不願意被列入《歡迎名單》中。 I opt to be INCLUDED from the Membership Directory. 我願意被列入《會員名冊》。I opt to be EXCLUDED from the Membership Directory. 我不願意被列入《會員名冊》。 Section 6: Sponsor 推薦人 Sponsor Name 推薦人姓名 Tel 電話 Email 電郵 Section 7: Completion of Application Form 完成申請表格 A 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。 A 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。] A business card. 名片一幀。 Section 8: Please Write Your Signature in the Box Below 請在下方簽名