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Title*
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Name in Chinese
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Name in English*
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| Date of Birth* |
year month day |
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ID Document Type*
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ID card
Passport
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ID/Passport No.*
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Nationality
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Correspondence Address
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City
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Province
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Country
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Contact Phone No.
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- |
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Email Address*
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Preferred correspondence method to receive information*
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by eMail
by phone
by Mail
Other
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Marital Status
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Single
Married
Other
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Preferred correspondence method to receive information, if any
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Mail
Email
Phone
SMS
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Declaration before signature:
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I hereby declare that I am aged 18 years or above and all the information given in this application form are true.
I confirmed that I have read and understood the terms and conditions of Ponte 16 Membership in this promotional leaflet.
Yes
No
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