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Membership Application Form



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Name and Address of Licence Holder
English name
Chinese name
Registered Address

General Information
Tel. No
Fax No.
Email Address
Money Lender Licence No.
Licence Expiry Date:
Total No. of Branches#
Already a member of other financial organizations? Please indicate and/or mark the details if applicable.
Others please specify

Type of Membership Applied
Please select group Total No. of Branches# Admission Fee (HK$) Annual Fee (HK$)
40 or above 50,000 40,000
30 ‐ 39 40,000 30,000
20 ‐ 29 30,000 20,000
15 ‐ 19 20,000 15,000
10 ‐ 14 15,000 3,000
6 ‐ 9 10,000 2,000
1 ‐ 5 5,000 1,000

Contact Particulars
Name in English
Name in Chinese
Position
Tel. No.
Fax No.
Email Address
Date
# Total No. of branches includes Head Office and all branches as at the date of this application. Location with ATM machines only is excluded for branch calculation.

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