Wealth Creator Universal Life Plan Registration Service | Fubon Bank Wealth Creator Universal Life 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: YesYes NoNo Title: Mr Mrs Miss Ms Name: HK Contact No.: Preferred Opening Branch: Please choose Central Main Branch Western District Branch Queen's Road East Branch Causeway Bay Branch North Point Branch Tsim Sha Tsui Branch Mong Kok Branch Mei Foo Branch Kwun Tong Branch Hung Hom Branch Tsuen Wan Branch Yuen Long Branch Tai Po Branch Shatin Branch Taikoo Shing 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 personaldata in direct marketing*: hasNoOptOut 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: 1. The Plan is an insurance product, but not a bank savings plan embedded with a life insurance. The premium is not a placement of a savings deposit with the bank and hence is not protected by the Deposit Protection Scheme in Hong Kong. 2. Fubon Life is solely responsible for all content, approvals, coverage and benefit payment of the Plan. Fubon Life reserves the right to accept and reject any insurance application. 3. Fubon Life is fully responsible for all the above information. 4. The above information is intended for reference only. All the policy terms and conditions are set out in the policy provisions of the Plan. For more information of the policy terms and conditions, please contact the staff of Fubon Bank. 5. The above information shall not be construed as an offer to sell or solicitation to buy or provision of any insurance of Fubon Life outside Hong Kong. 6. Levy collected by the Insurance Authority will be imposed on the policy at the applicable rate, which would be borne by Fubon Life Insurance (Hong Kong) Company Limited (“Fubon Life”) on behalf of policyowners and remitted in accordance with the prescribed arrangements. Fubon Life will review the payment arrangement of levy on insurance premium regularly and reserves the right to revise the arrangement. For further information, please visit Fubon Life’s company website or contact Fubon Life Customer Service Hotline at (852) 2516 0133. 7. Fubon Life is the private company limited by shares incorporated and registered in Hong Kong and the registered office is situated at Suites 301-303, 3/F, Cityplaza 4, 12 Taikoo Wan Road, Taikoo Shing, Hong Kong.