ATM Card Maintenance / Cancellation Form

ATM Card Maintenance / Cancellation Form
星展銀行 (香港) 有限公司
To: DBS Bank (Hong Kong) Limited (the “Bank”, which expression should include its successors and assigns)
此表格備有中文及英文版。如你選用此表格(英文版)提交申請,即表示你同意選用英文版之表格及明白表格內之全部內
容。This order form is available in both English & Chinese versions. By completing this form, you agree to use this
English version and confirm that you understand all its contents set out below.
Date
/
DD
/
MM
YY
Branch
Please complete this form in BLOCK LETTERS, place a  where appropriate and delete as appropriate and cross out any of the unused spaces.
Cardholder’s Name
HKID Card/Passport Number
@
Mobile Phone Number
(Required for DBS Octopus ATM Card
holder only)
Date of Birth (dd/mm/yy)
(Required for DBS Octopus
ATM Card holder only)
Account No. on ATM Card
□ ATM Card with China UnionPay Services
@
Note: For an overseas phone number, please add country code and area code (if any) in front of the number.
A. Amend Accounts(s) Linked to ATM Card
Account(s) in same name to be added / deleted : (A maximum of two accounts can be added per card)
Account No.
Signatures(s)
For Bank Use Only (S.V.)
Add / Delete
Add / Delete
Add / Delete
Total Number of Account(s) in same name to be added / deleted :
Add
Delete __________________________
B. Apply for ATM Card Replacement or Change of Card Type
Important Notes on DBS Octopus ATM Card:
1. The Octopus Automatic Add Value Service (“AAVS”) of DBS Octopus ATM Card would be automatically activated by the Bank at the time
of card issue. AAVS amount will be debited from the designated account starting from the first AAVS transaction. If you do not want to use
the AAVS, please choose DBS ATM Card (without Octopus function).
2. Please note that the Bank will send important notes for the use of DBS Octopus ATM Card, e.g. card issue date, status of ATM card
acknowledgement etc, to you via SMS. The SMS will be sent to the mobile phone number provided by the applicant in this application form.
□
□
I/We would like to apply for replacement of the above card for the following reason:
□
Card Damaged/Inoperable
□
Card Not Received
□
Card Lost/Stolen – Date and Time Lost/Stolen: ______________________
□
PIN Lost/Forgotten/Inoperable
□
Card Captured by ATM
□
Other – please specify: _________________________________________
I/We would like to apply for changing of the type of the above card to :
□
DBS Octopus ATM Card with China UnionPay Services (only applicable to DBS Treasures and DBS Account Customers)
Octopus AAVS amount for every auto-reload transaction is
HKD500
HKD250
Account No. of Designated HKD Current Account (“AAVS Account” +) for AAVS provided by Octopus Cards Limited ("OCL"):
______________________________________________
+
□
Overdraft Protection (if any) will cover any overdraft on the AAVS Account from time to time (including any overdraft incurred by using AAVS), which
could be extensive and will be subject to payment of overdraft interest and other charges pursuant to the Bank Accounts and Services Terms and
Conditions. Please contact our branch staff if you wish to apply or discontinue the Overdraft Protection services.
□
DBS ATM Card (without Octopus function)
□ DBS Treasures Private Client/DBS Treasures/DBS Account ATM Card with China UnionPay Services
□ General ATM Card with China UnionPay Services
□
Fast Cash Card (only applicable to customers aged 65 or above)
I/We would like to change the Octopus AAVS amount for every auto-reload transaction for my/our DBS Octopus ATM Card to
HKD500
HKD250
C. Report Lost, Cancel or Receive ATM Card
□ My/Our ATM Card has previously been reported lost but has now been located. Please reactivate my/our ATM Card (not applicable to DBS Octopus ATM
Card).
□
Please cancel my/our ATM Card.
□
I/We have received from you my/our ATM Card captured by ATM on
/
/
(DD/MM/YY).
D. Amend Transaction Limits of ATM Card Account
□ Please set my/our following maximum daily limit(s) of the above ATM card (in multiple of HKD/RMB1,000) according to the following instruction:
(Except for HK Jockey Club cash voucher, the maximum limit is HKD/RMB999,000.)
□ Cash Withdrawal
□ Transfer to A/C within same card
□ POS payment
(HKD
)
(HKD/RMB
)
(HKD
)
□ HK Jockey Club cash voucher
□ PPS Debit
□ Transfer to A/C NOT within same card
(HKD
)
(HKD
)
(HKD
)
This limit amount is inclusive to POS payment limit,
its maximum amount must not exceed HKD50,000
or my/our personalized POS payment limit
whichever is lower.
Hong Kong/CBG/BOS/1118(09/15)
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DBS Bank (Hong Kong) Limited
E. Acknowledge Receipt of New ATM Card or PIN
□ I/We acknowledge receipt of
□ the above new card
□ the PIN, sequence no. (card with China UnionPay Services)
, please issue the card to me/us.
S.V.
_______________________________________________________
F. Amend DBS Octopus ATM Card Related Services
□
Please change the Designated HKD Current Account for AAVS provided by OCL to Account No.: _______________________________________________
G. Overseas Cash Withdrawal Setting
□
Activation
Start Date: ______________________
End Date: ______________________
Maximum Daily Limit (HKD): _______________________
The Start Date should be set as a date not earlier than the next bank business day (which does not include Saturdays) after this form is submitted to the
Bank.
The End Date should not be set beyond the expiry date of your ATM Card.
□ Deactivation
H. Others
□ Others:
_________________________________________________________________________________________________________________________________
Notes:
1. The Bank will verify the applicants’ signature(s) with the specimen signature(s) of any one of the above mentioned accounts filed with the Bank.
2. The account(s) will also be added to / deleted from supplementary card(s), if any.
3. The first time the cardholder uses the Card at ATM after the linked account(s) is/are added/deleted, a message “TRANSACTION CANCELLED” will
be displayed on screen. Please ignore this message and perform the transaction again (Not applicable to re-issued card).
4. Transaction limits of the newly added account(s) will be preset to the Bank’s prevailing limits. The applicant(s) should fill in Part D of this form to set
up personalized transaction limits (if necessary).
5. The Bank shall be entitled to levy a reasonable charge for issuance, re-issuance and use of the Card or PIN, as shown in the Bank Charges
Schedule.
6. The English version shall prevail if there is a discrepancy between the English and Chinese versions.
Customer’s Declarations
I/We confirm that the information provided above is true and complete and that I/we have read and agree to comply with the applicable terms and conditions and
the Data Policy Notice of the Bank, from time to time in force, copies of which are available on request at any branch of the Bank or from the Bank’s website
(www.dbs.com/hk). I/We hereby authorize the Bank to debit any fees and charges payable for this application (such as card replacement fee) (if any) from the
Primary Account linked to the card and to send any card to my/our correspondence address registered with the Bank. I/We confirm that I/we accept full
responsibility for all transactions effected with the correct PIN, by the Bank, acting in good faith, irrespective of whether such transaction(s) is/are authorized by
me/us.
For DBS Octopus ATM Card Application :
I/We have received the DBS Octopus ATM Card Terms & Conditions from the Bank. I/We declare that by applying for the DBS Octopus ATM Card and using
AAVS, I/we have read, accept and agree to, and shall be bound by, the DBS Octopus ATM Card Terms & Conditions specified and amended by the Bank from
time to time. Some of the major provisions of the DBS Octopus ATM Card Terms & Conditions are set out below for emphasis only (and I/we shall be bound by all
the DBS Octopus ATM Card Terms & Conditions whether or not set out below):
1. Use of the DBS Octopus ATM Card is subject to:
(a) the DBS Octopus ATM Card Terms & Conditions;
(b) the Bank Accounts and Services Terms and Conditions;
(c) the Octopus Automatic Add Value Agreement, as may be specified and amended by OCL from time to time;
(d) the Conditions of Issue of Octopus, as may be specified and amended by OCL from time to time; and
(e) the Terms and Conditions for Octopus Rewards Programme, as may be specified and amended by Octopus Rewards Limited from time to time.
2. AAVS Account
(a) I/We authorize the Bank to debit from or credit to the AAVS Account all amounts in relation to AAVS in accordance with instructions received from time to
time by the Bank from OCL regarding me/us. For the avoidance of doubt, the Bank is not required to notify me/us or obtain my/our consent before acting
on OCL's instructions.
(b) I/We shall be liable for all amounts from time to time added or reloaded pursuant to the Octopus stored value function on the DBS Octopus
ATM Card through AAVS and the AAVS Account.
(c) If the DBS Octopus ATM Card is terminated for any reason, the Bank is entitled to:
(i) set off any remaining value stored on it pursuant to the Octopus stored value function against any outstanding indebtedness owing by me/us to the
Bank; and/or
(ii) deduct any amount from the AAVS Account and apply it towards settlement of any debit balance in the Octopus stored value function.
3. Overdraft
(a) I/We shall ensure there are sufficient funds (which may include pre-arranged overdraft facilities granted by the Bank) in the AAVS Account to effect
transactions in accordance with OCL's instructions regarding me/us from time to time. I/We authorize the Bank to effect a transaction even if there are
insufficient funds in, or insufficient pre-agreed overdraft limit on, the AAVS Account and I/we shall be liable for the resulting overdraft (including any
overdrawn amount which exceeds the pre-agreed overdraft limit) in the AAVS Account.
(b) Any overdraft (including any overdrawn amount which exceeds the pre-agreed overdraft limit) shall be subject to the provisions of the Bank Accounts and
Services Terms and Conditions, and my/our rights and obligations shall be determined accordingly.
(c) Without prejudice to the generality of paragraph (b) above:
(i) the Bank is entitled to impose the prevailing overdraft interest and other charges specified in the Bank Charges Schedule made available by the Bank
from time to time;
(ii) I/we shall repay to the Bank upon demand any overdrawn amount on the AAVS Account, together with interest and charges imposed by the Bank; and
(iii) the Bank reserves the right to cancel the DBS Octopus ATM Card without prior notice to or consent from me/us if I/we fail to comply with paragraph (ii)
above.
(d) I am/We are responsible for monitoring the balance on the AAVS Account at all times. The Bank may (but is not obliged to) inform me/us of any overdraft
on the AAVS Account as a result of use of AAVS by any means as the Bank may consider appropriate.
4. Personal Data
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DBS Bank (Hong Kong) Limited
I/We consent to and authorize the Bank to disclose to OCL and ORL my/our personal data (whether collected by the Bank via the applicable
application form or by other means or otherwise in the possession of the Bank from time to time). The data that may be provided to OCL include
name, gender, date of birth, HKID card number/passport number, contact information and the AAVS Account number of me/us. The data that may
be provided to ORL include name, gender and contact information of me/us, and preferred contact language. I/We consent to and authorize OCL
and ORL to use my/our personal data for the following purposes:
(a) processing my/our request for Octopus functions and related services (including AAVS) provided by OCL;
(b) processing my/our request to register as a member of the Octopus Rewards Programme operated by ORL;
(c) providing Octopus functions and related services (including AAVS) provided by OCL and such other purposes of use of the personal data in
accordance with the Conditions of Issue published by OCL, but, in any event, OCL shall not use such personal data for the purpose of direct
marketing;
(d) providing Octopus Rewards services under the Octopus Rewards Programme and such other purposes of use of the personal data under the
Octopus Rewards Programme in accordance with the Terms and Conditions for Octopus Rewards Programme published by ORL, but, in any
event, ORL shall not use such personal data for the purpose of direct marketing; and
(e) purposes otherwise relating to the cooperation arrangement between the Bank and OCL pursuant to which the DBS Octopus ATM Card is
issued and administered.
5. ATM Card Termination
The Bank reserves the right to terminate the DBS Octopus ATM Card at its discretion upon:
(a) the Bank becoming aware of any abnormal activities or transactions involving the DBS Octopus ATM Card;
(b) accumulation of an overdraft amount on the AAVS Account with no pre-arranged overdraft facilities;
(c) accumulation of an overdraft amount on the AAVS Account in excess of existing pre-arranged overdraft facilities;
(d) I/we fail to perform ATM Card acknowledgment or use the DBS Octopus ATM Card within the designated period set by the Bank; or
(e) termination for any reason of the cooperation arrangement between the Bank and OCL pursuant to which the DBS Octopus ATM Card is issued and
administered.
Upon termination of the DBS Octopus ATM Card by the Bank, the ATM functions and the Octopus functions of the DBS Octopus ATM Card could both cease
to be operable.
Acknowledgement of Use of My/Our Personal Data in Direct Marketing
I/We understand that the Bank intends to use my/our personal data in direct marketing and cannot do so without my/our consent. I/We have previously selected
whether or not to receive direct marketing contact or information and I/we confirm that there is no change to my/our existing choice and all information provided in
this application form shall be used in accordance with such choice. I/We understand that if I/we wish to change my/our existing choice, I/we may do so at any time
and without charge by completing an opt-out form and returning it to the Bank.
Please confirm that your instructions have been clearly, accurately and completely set out in this form before signing it.
Cardholder’s Signature
(Signature must agree with the specimen signature filed with the Bank)
For Bank Use Only
Branch
Card Type
□ “0” = Main Card
Card returned
□Yes □No
□ Card Enclosed
□ Card not Enclosed
‘Hot’ placed by
___________________
□ “1” = Supp. Card
Card returned
□Yes □No
SSB
Address: □Checked Initial the action(s) taken:
SV
AHV
Approved by
(Signature with No.,
Name & Date)
S.V.
Input
Approved
Attended by:
(Signature, Name &
Date)
□ DBS Octopus ATM Card
report loss/ cancellation
without returning the
Card, SSB informed by
Card shredded on:
Shredded by (Initial)
___________________
(Mark name & date if
different from the
attending staff.)
Hong Kong/CBG/BOS/1118(09/15)
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DBS Bank (Hong Kong) Limited