Customer Declaration

Customer Declaration

The issue of any Citi Credit Card to me will be accompanied by the relevant Citi Credit Card Agreement/the Conditions of Issue of Octopus and Octopus Automatic Add Value Agreement issued by Octopus Cards Limited ("OCL")/the Terms and Conditions for Octopus Rewards Programme issued by Octopus Rewards Limited ("ORL"), whichever is applicable (each an "Agreement", as amended from time to time), copies of which are also available upon request and the Agreements provided by OCL and/or ORL can be obtained from the Octopus website,

I may from time to time apply for further Citi Credit Cards from Citibank and Citibank may issue the same to me without a written acknowledgement of the relevant Agreement(s).

I agree that all Terms and Conditions of the Agreements, the Policy Statement relating to the Personal Data (Privacy) Ordinance ("Policy Statement") and this form will constitute my agreement with Citibank for the application and the use of such Citi Credit Card.

For Citi Prestige Card: I agree Citibank to submit my name and Asia MilesTM membership number to Asia Miles Limited for the fulfillment of the welcome offer.

If you do not wish Citibank to provide your personal data to Octopus Cards Limited/Octopus Rewards Limited regarding Citi Octopus Platinum Card/Citi Octopus Gold Card, please indicate your preference in the section of "Opt-out from Use of Personal Data in Setting Up Octopus Automatic Add Value Service and Enrolling for the Membership of the Octopus Rewards Programme".

To help prevent money laundering and terrorist financing, the laws of many jurisdictions, as well as Bank' s policy, I understand that you will require me to provide information that identify me who apply for a credit card with Citibank and that such information will be verified and recorded. When I apply for a credit card, you will ask for my name, address, date of birth, and other information that will allow you to identify me. You will also ask to see and retain a copy of my photo ID or other identifying documents.

I warrant that all the information provided in this form is correct and complete. I understand that Citibank will only update any change to my existing records (if applicable) after successful identity verification. I accept after successful verification, Citibank will contact me for information about my use of Citibank services and product & services alerts including but not limited to receiving e-statements (on subscription) and other promotional/ marketing materials. However, in the event of unsuccessful verification or card application, I understand that the bank will not update its records and will continue to use my existing record to contact me. I will update Citibank immediately on any subsequent changes to the above information. I authorize Citibank to verify the information provided in respect of this form from and/or exchange it with any source. I also understand that account opening and/or the provision of any service by Citibank is subject to Citibank’s internal approval, and is subject to my full acceptance of the relevant Terms and Conditions, agreements and declarations in respect of this form.

I warrant that (i) I am not bankrupt; (ii) no petition for bankruptcy is presented against me; (iii) I am not insolvent.

Definition on relationship with Citibank directors / employees / controllers / minority shareholder controllers:

1. "Relative" is defined under Rule 85(4) of the Banking (Exposure Limits) Rules (Cap.155S) as: (a) a parent, grandparent or great grandparent; (b) a step-parent or adoptive parent; (c) a brother or sister; (d) the spouse; (e) if the person is a party to a union of concubinage – the other party of the union; (f) a cohabitee; (g) a parent, step-parent or adoptive parent of a spouse; (h) a brother or sister of a spouse; (i) a son, step-son, adopted son, daughter, step-daughter or adopted daughter; or (j) a grandson, granddaughter, great grandson or great granddaughter.

2. "Controller" is defined under Section 2 of the Banking Ordinance (Cap.155) as, in relation to a company : (a) an indirect controller (i.e. any person in accordance with whose directions or instructions the directors of the company or of another company of which it is a subsidiary are accustomed to act, but does not include a Manager or Advisor appointed under Section 52 of the Banking Ordinance (Cap.155) or any person in accordance with whose directions or instructions those directors are accustomed to act by reason only that they act on advice given by him in his professional capacity); or (b) a majority shareholder controller (i.e. any person who, either alone or with any associate or associates, is entitled to exercise, or control the exercise of, more than 50% of the voting power at any general meeting of the company or of another company of which it is a subsidiary).

3. "Minority shareholder controller" is defined under Section 2 of the Banking Ordinance (Cap.155) as, in relation to a company : any person who, either alone or with any associate or associates, is entitled to exercise, or control the exercise, or control the exercise of, 10% or more, but not more than 50%, of the voting power at any general meeting of the company or another company of which it is a subsidiary.

I acknowledge receipt of the Citibank Credit Card Key Facts Statement And Fees Schedule, the Major Terms and Conditions of Citi Credit Card Cardholder/Cardmember Agreement and the Policy Statement.

I confirm, agree and accept that:

(i) I wish to apply for Citi Credit Card that I have selected above and understand that Citibank will review my credit report from the Credit Reference Agency in assessing this application or other credit facilities provided to me.

(ii) Application process will start immediately and will take a few steps to complete. Citibank will immediately access my credit report from the Credit Reference Agency in the course of this application notwithstanding I may not have already completed all the steps. Such access will be recorded in my credit reference report immediately and cannot be undone, even if I do not complete all the application steps or that this application is unsuccessful or cancelled.

I understand that you, your employees, your authorized agents or any of your affiliates may act in different capacities, and may be remunerated, or may receive benefits or profits, either directly or indirectly in connection with the services provided. The remuneration of your employees or authorized agents may comprise a fixed pay and/or a variable compensation which is determined by a number of factors including the sales performance.

If I currently hold an Octopus and I am applying for a Citi Octopus Platinum Card/Citi Octopus Gold Card above, my existing Octopus with its associated services will NOT be transferred or cancelled upon approval of this application. A new Octopus (with a new Octopus ID) will be embedded in the Card once this application has been approved. The total outstanding balance, security access and Octopus Reward$ earned in my existing Octopus will NOT be transferred to my new Octopus created under this application. If needed, I will need to contact the relevant service provider.

I understand that all information obtained by Citibank during the credit card application process is necessary (unless otherwise specified as optional) for Citibank to process my application and if I fail to provide the same to Citibank, Citibank will not be able to issue any card or provide any services to me. I agree that my personal data and information collected by Citibank from time to time may be used and disclosed for such purpose and to such persons (whether in or outside Hong Kong) as set out in the Policy Statement.

With respect to this form and any other relevant documents, in case of any discrepancy between the English and Chinese version, the English version shall prevail.