1008World-WideHouse,19DesVoeuxRoad,Central,Hong.docVIP

1008 World-Wide House, 19 Des Voeux Road, Central, Hong Kong 香港德輔道中19號環球大廈1008 Tel電話: 852 2889 9986 Fax傳真: 852 2889 9982 E-mail電郵: executive@ Web-site網頁: Applicant’s Experience申請人年資:- A: Total Work Experience全部工作經驗 Years年 B: Director / Equivalent Experience董事或相約職務經驗 Years年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 # 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 d/mm/yyyy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 Name of Current Principal Company in Chinese and English 現時所屬主要公司中文及英文名稱 Co Legal Status 公司法律地位 Code代號** Position in Chinese and English 職位中文及英文名稱 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. If appointed as Director in other companies, please include on an attached sheet maximum 3 such appointments, supplying company name, company legal status and position held for each appointment. 如有在其他公司擔任董事，請附頁提供最多三項任命，每項請填寫公司名稱、公司法律地位、職稱。 Group applicable to Special Offer for Group Entrance 團體 適用於「集體入會優惠」 : Declaration: I hereby apply for membership of The Hong Kong Institute of Directors and agree to be bound by its Memorandum and Articles of Association and Membership Accreditation Scheme*. I confirm that I have not been disqua