Fubon Personal Accident Insurance Plan Registration Service

For registration and more details on Fubon Insurance Service, you are required to fill in the following details (unless otherwise specified), otherwise the Bank will not be able to contact you. After receiving your enquiry registration, our Customer Services Officer will contact you shortly.

*Optional

Existing Fubon Bank Customer:

Yes No

Title:

Mr Mrs Miss Ms

Name:

HK Contact No.:

Preferred Opening Branch:

E-mail Address*:

PDPO Statement:

By ticking this box, I confirm that I have read and understood and agree to be bound by your Bank’s Notice to Customers and Other Individuals relating to the Personal Data (Privacy) Ordinance and Consumer Credit Data, and agree that your Bank may use my information provided above to contact me and follow up on my enquiry above.

Opt-out from use of personal
data in direct marketing*:

I do not wish the Bank to use my personal data in direct marketing or provide my personal data to the Bank’s group companies for their use in direct marketing, in which includes Personal Loan promotions and other offers. The above represents your present choice whether or not to receive direct marketing contact or information. This replaces any choice communicated by you to the Bank prior to this application. Please note that your above choice applies to the direct marketing of the classes of products, services and/or subjects as set out in the Bank’s Notice to Customers and Other Individuals relating to the Personal Data (Privacy) Ordinance and Consumer Credit Data (attached to this form). Please also refer to the Notice on the kinds of personal data which may be used in direct marketing and the classes of persons to which your personal data may be provided for them to use in direct marketing.

Note: If you have also applied to other products or services of our Bank, you may be contacted by more than one Customer Services Officer.

Disclaimers:
a.The above information is for reference only and does not constitute any part of the insurance contract. For full terms and conditions and exclusions, please refer to the policy document itself which shall prevail in case of inconsistency.
b.Zurich Insurance Company Ltd is the insurance underwriter of the above insurance plan and is authorized and regulated by the Insurance Authority. Zurich Insurance Company Ltd is solely responsible for all approvals, coverage and compensation under this policy and reserves the right of final approval and decision on such matters.
c.Zurich Insurance Company Ltd is not a subsidiary or an affiliate of Fubon Bank (Hong Kong) Limited (“Fubon Bank”).
d.Fubon Bank is the authorized insurance agency for Zurich Insurance Company Ltd, and is responsible for introduction of the insurance plans. The Plan is not the product of Fubon Bank. Fubon Bank is not responsible for any terms or obligations of the Plan.
e.In case you file a written complaint regarding the selling process or processing of the related transaction to Fubon Bank and the complaint is an “Eligible Dispute(s)” as defined in the Terms of Reference for the Financial Dispute Resolution Centre, Fubon Bank is required to enter into a Financial Dispute Resolution Scheme process with you if the Eligible Dispute cannot be resolved after Fubon Bank has issued the final written reply. If the complaint / dispute is related to the policy terms and conditions, it should be resolved directly between Zurich Insurance Company Ltd and you.
f.Levy collected by the Insurance Authority (if any) has been imposed on this policy at the applicable rate and would be remitted in accordance with the prescribed arrangements. For further information, please visit http://www.zurich.com.hk/ia-levy.
g.Zurich Insurance Company Ltd is a company incorporated in Switzerland with limited liability and its principal place of business in Hong Kong is at 25-26/F, One Island East, 18 Westlands Road, Island East, Hong Kong.
h.The English version shall prevail in case of inconsistency between the English and Chinese versions.