Standard Chartered Bank (Hong Kong) Limited

Hong Kong

Please provide the below details. Our Relationship Manager will contact you shortly to make an appointment for a professional Financial Needs Analysis.

Salutation:

Mr. Ms. Mrs.

Name (in full):

Contact number:

Preferred Contact time (Only office hours are available):

Preferred branch for conducting the Financial Needs Analysis:

District: Area:

Which items below you are interested in (note: you may choose more than one item):

	Savings & Life Protection
	Health / Accident Protection
	Retirement Planning & Life Protection
	Children Education & Life Protection
	Estate Planning & Life Protection
	Others

Are you an existing customer of Standard Chartered:

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Note: Personal data supplied by you on this form is intended to be used for this appointment only and will not be updated to your prevailing record by us.

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We will contact you shortly for a Financial Needs Analysis arrangement (provided that your contact number is valid).

Note: The life assurance plans are life insurance products underwritten by Prudential Hong Kong Limited (a member of Prudential plc group) ("Prudential") and distributed by Standard Chartered Bank (Hong Kong) Limited (“Standard Chartered”). Some of these plans may have a savings element, in which case, part of the premium will be used to pay for the insurance and related costs. A customer who has bought the life assurance plans has a right to cancel the policy within the cooling-off period and obtain a refund of any premium(s) paid less any withdrawals. Provided that no claim has been made, the customer may cancel the policy by giving written notice to Prudential within 21 days after: (a) the delivery of the policy or (b) the issuance of a notice (informing the availability of the policy and expiry date of the cooling off period) to the customer/his/her representative, whichever is earlier. After the cooling off period expires, if a customer cancels the policy before the end of its policy term, the actual cash value may be substantially less than the total amount of premiums paid.

Standard Chartered is an insurance agent of Prudential.

As the issuer of the life assurance plans, Prudential will be responsible for all protection and claims issues. Prudential is not an associate or subsidiary company of Standard Chartered. This material is not a contract of insurance. Please refer to the policy for full terms and conditions. Standard Chartered does not accept any responsibilities regarding any statements provided by Prudential or any discrepancies or omissions in the contract of insurance nor shall Standard Chartered be held liable in any manner whatsoever in relation to your contract of insurance.

This material is intended to be distributed in Hong Kong only and shall not be construed as an offer to sell or solicitation to buy or provision of any insurance product outside Hong Kong. Prudential and Standard Chartered do not offer or sell any insurance product in any jurisdictions outside Hong Kong in which such offering or sale of the insurance product is illegal under the laws of such jurisdictions. This material does not constitute a contract of insurance or an offer, invitations or recommendation to any person to enter into any contract of insurance or any transaction described therein or any similar transaction.

Whether to apply for insurance coverage is your own individual decision. For Prudential’s life assurance plan policy provisions, details and risk disclosure please refer to relevant plan’s product leaflet/offering document and specimen policy.

I have read and fully agreed the details and relevant notes of this appointment.

Issued by Standard Chartered Bank (Hong Kong) Limited


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