Dah Sing Credit Card Cash-In Plan Application Form

Please complete the application form in English.

Credit Card Cardholder Name: (as printed on credit card) Please select titleMr.Mrs.Miss Dah Sing Credit Card Account Number: (Applicable to Principal Credit Cardholder) - - - Daytime Local Contact Number: Loan Amount Requested (HK$): (Minimum amount is HK$3,000) Tenor Requested: 6-month 12-month 18-month 24-month 36-month 48-month 60-month Name of Bank for Disbursement: Please disburse the Loan Amount to my designated personal Hong Kong Dollars Savings account (joint account / credit card account / loan account are not applicable) numbered as: Promotion Code (if applicable):

I confirm my application for Dah Sing Credit Card Cash-In Plan. I have read, understood and agree to be bound by "Dah Sing Credit Card Cash-in Plan Terms and Conditions", "Notice to Customers relating to Customers' Data" and "Key Facts Statement".