2104ShanghaiIndustrialInvestmentBuilding,48Hennessy.docVIP

2104 Shanghai Industrial Investment Building, 48 Hennessy Road, Wan Chai, Hong Kong 香港灣仔軒尼詩道48號上海實業大廈2104 Tel電話: 852 2889 9986 Fax傳真: 852 2889 9982 E-mail電郵: executive@ Web-site網頁: Membership Grade Applied For申請會員級別: Fellow資深會員 Member 會員 Associate附屬會員 Affiliate 連繫會員 Office Use請勿填寫 Section : 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 # 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: 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: Company 公司 Home住宅 Section : Work and Board Director Experiences 工作年資及董事經驗 Applicant’s Experience申請人年資: Total Work Experience全部工作經驗 Years年 Board Director / Equivalent Experience董事或相約職務經驗 Years年. List of directorships, 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 and Chinese 職位英文中文名稱 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 5 5-10 10 No. of Employees公司僱員人數 1-10 11-50 51-100 101-500 501-1,000 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 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. Section 4: Corporate Scheme in Enrolment Group Organisation Offer公司集體入會優惠／集團優惠 [Please insert a “ ” if applicable