account opening application form joint account香港香葉道2 號one island south 大廈8 樓9 室...

Room 9, 8/F, One Island South, 2 Heung Yip Street, Hong Kong 香港香葉道 2 號 One Island South 大廈 8 樓 9 室

Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005

Web-site 網址: www.zjsec.com.hk

Exchange Participant of the Stock Exchange of Hong Kong Limited

香港聯合交易所之參與者

Licensed Corporation of the Securities and Futures Commission

證券及期貨事務監察委員會之持牌法團

CE No. 中央編號: BHO840

Aug 2017

Account Type 帳戶類別 Account No. 帳戶編號 Fees

收費

口 Cash (Phone Trading)

現金帳戶 (電話交易)

□________ % with HK$_______min.最低

口 Online Cash

電子現金帳戶

□________ % with HK$_______min.最低

口 Margin (Phone Trading)

保證金帳戶 (電話交易)

□________ % with HK$_______min.最低

口 Online Margin

電子保證金帳戶

□________ % with HK$_______min.最低

Account Name

帳戶姓名

AE Name

經紀名稱 AE Code

經紀編號

ACCOUNT OPENING APPLICATION FORM

JOINT ACCOUNT

開戶申請表格

聯名帳戶

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Account Opening Application Form - Joint Account 開戶申請表格 - 聯名帳戶

Main Account Holder 主要戶口持有人 Joint Account Holder 聯名戶口持有人

1. Name 姓名

In Chinese 中文 In English 英文

In Chinese 中文 In English 英文

2. Personal Information 個人資料

Residential Address 住宅地址

____________________________________________________________________

____________________________________________________________________

Please provide residential address proof within the latest 3 months

請提供最近三個月之住宅地址證明


____________________________________________________________________

____________________________________________________________________

Please provide residential address proof within the latest 3 months

請提供最近三個月之住宅地址證明

ID No. or Passport No.

身份證號碼或護照號碼 ID No. or Passport No.

身份證號碼或護照號碼

Type of ID/ Passport 身份證/護照種類

口 HK Identity Card 香港身份證口 Chinese Identity Card 中國身份證

口中國護照 Chinese Passport 口other, 其他地區/國家護照:______________

Type of ID/ Passport 身份證/護照種類

口 HK Identity Card 香港身份證口 Chinese Identity Card 中國身份證

口中國護照 Chinese Passport 口other, 其他地區/國家護照:______________

Date of Birth 出生日期 Sex 性別 Nationality 國籍 Date of Birth 出生日期 Sex 性別 Nationality 國籍

Born in the U.S. 於美國出生 ? 口 No 否口 Yes 是

U.S. citizen, green card holder, or residing in U.S.?

是否美國公民、綠咭持有人、或居住於美國？口 No 否口 Yes 是

If Yes, please provide Taxpayer Identification Number :

如是，請提供美國納稅人識別號碼：_______________________

Born in the U.S. 於美國出生 ? 口 No 否口 Yes 是

U.S. citizen, green card holder, or residing in U.S.?

是否美國公民、綠咭持有人、或居住於美國？口 No 否口 Yes 是

If Yes, please provide Taxpayer Identification Number :

如是，請提供美國納稅人識別號碼：_______________________

Education Level 學歷：

口Primary小學口Secondary中學

口Post-Secondary預科或大專口University or above本科/大學或以上

Education Level 學歷：

口Primary小學口Secondary中學

口 Post-Secondary 預科或大專口 University or above 本科/大學或以上

Mobile Phone

手提電話

Residential Phone

住宅電話 Facsimile No.

傳真號碼 Mobile Phone

手提電話

Residential Phone

住宅電話 Facsimile No.

傳真號碼

Email Address 電郵地址 (Mandatory for electronic trading 電子交易必須填寫)

Email Address 電郵地址 (Mandatory for electronic trading 電子交易必須填寫)

Select your language選擇語言: 口繁體口簡體口 English

3. Employment Status 工作狀況

Employment Status 工作狀況

口Employed 受僱口Self-employed 自僱口Retired 退休

口Housewife 主婦口 Others 其他 _______________________

Employment Status 工作狀況

口Employed 受僱口Self-employed 自僱口Retired 退休

口Housewife 主婦口 Others 其他 _______________________

Name of Employer 僱主名稱 Occupation (or Nature of Business) 職業 (或業務性質)

Name of Employer 僱主名稱 Occupation (or Nature of Business) 職業 (或業務性質)

Position 職位 Year(s) of Service 服務年資 Position 職位 Year(s) of Service 服務年資

Business Address 公司地址

Business Address 公司地址

Business Phone 公司電話

Business Phone 公司電話

Relationship between Main Account Holder and Join Account Holder (if applicable) 聯名帳戶主要戶口持有人與聯名戶口持有人關係 (如適用)

4. Method of Communication 通訊方式

Please choose one of the following method of communication only 請只選擇其中一項通訊方法:

口 By Post to Correspondence address 郵寄至通訊地址 (please provide correspondence address proof within latest 3 months 請提供最近三個月之通訊地址證明)

口 Residential Address 住宅地址口 Business Address 公司地址口 Other Address 其他地址_________________________________________________________

(Please note that the statement will be sent to Main Account Holder 請留意結單將以郵遞方式寄往主要戶口持有人)

口 By Email 電子郵件

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5. Financial Background 財務狀況

Source of Funds /Wealth 資金 / 財富來源

口 Salary and/ or bonus 薪金及／或花紅

口 Commission 佣金

口 Business Income 業務收入

口 Return on Investment 投資回報

口 Saving 儲蓄

口 Retirement Funds 退休金

口 Others 其他 (Please specify 請說明) _____________________

口 Salary and/ or bonus 薪金及／或花紅

口 Commission 佣金

口 Business Income 業務收入

口 Return on Investment 投資回報

口 Saving 儲蓄

口 Retirement Funds 退休金

口 Others 其他 (Please specify 請說明) _____________________

Annual Income (in HK$) 年薪 (以港幣計算)

口 less than 少於$250,000

口 $250,001 - $500,000

口 $500,001 - $1,000,000

口 more than 多於$1,000,000

口 less than 少於$250,000

口 $250,001 - $500,000

口 $500,001 - $1,000,000


Approximate total asset value (in HK$) (including real estates, cash deposits at Bank, shares, bonds, warrants)

資產總約值(以港幣計算) (包括物業、銀行存款、股票、債券、認股權證)

口 less than 少於 $50,000

口 $50,001 – $200,000

口 $200,001 – $500,000

口 $500,001 – $1,000,000

口 $1,000,001 – $5,000,000

口 $5,000,001 – $8,000,000

口 $8,000,001 – $40,000,000


口 less than 少於 $50,000

口 $50,001 – $200,000

口 $200,001 – $500,000

口 $500,001 – $1,000,000

口 $1,000,001 – $5,000,000

口 $5,000,001 – $8,000,000

口 $8,000,001 – $40,000,000


Ongoing Source(s) of Funds 持續資金來源:

a) Means of fund transfer(s) 資金轉移的方式:

口Cheque/ Bank Draft 支票／銀行本票

口Telegraphic Transfer 電匯

口Others 其他 (Please specify 請說明:______________)

b) Country(ies) of Origin(s) 資金來源地:

口Hong Kong香港口Mainland China中國內地口Macau澳門

口United States美國口Other其他 (Please specify 請說明:__________________)

Ongoing Source(s) of Funds 持續資金來源:

a) Means of fund transfer(s) 資金轉移的方式:

口Cheque/ Bank Draft 支票／銀行本票

口Telegraphic Transfer 電匯

口Others 其他 (Please specify 請說明:______________)

b) Country(ies) of Origin(s) 資金來源地:

口Hong Kong香港口Mainland China中國內地口Macau澳門

口United States美國口Other其他 (Please specify 請說明:__________________)

Main Account Holder 主要戶口持有人

6. Investment Experience 投資經驗

Securities Trading 證券交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Futures / Options Trading 期貨 / 期權交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Stock Options 股票期權交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Forex/Commodity Futures Trading 外匯/商品期貨交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Bullion Trading 貴金屬交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Derivative Warrants 衍生權證交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Callable Bull/Bear Contracts 牛熊證交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Exchange Traded Funds 交易所買賣基金交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Equity Linked Instruments 股票掛鈎票據交易口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Mutual Funds / Unit Trust 互惠基金 / 單位信託基金口 Yes 有 ( ) year(s) 年/ 口 No 沒有

Fixed Income Securities (e.g. Bonds) 固定收益證券 (例如債券) 口 Yes 有 ( ) year(s) 年/ 口 No 沒有

7. Risk Tolerance Assessment 風險承受評估

a) Investment Objective投資目標 (Please choose one of the options only 請只選擇其中一項)

口 Long Term 長期口 Medium Term 中期口 Short Term 短期

b) Risk Profile 風險屬性 (Please choose one of the options only 請只選擇其中一項)

口 Conservative 保守型口 Balanced 平衡型口 Growth 增長型口 Aggressive 進取型

8. Knowledge of Derivative Products 客戶對衍生産品的認識 (please tick as appropriate 請在適當空格加“✓”)

口 The Client will/may trade any derivative products, and has knowledge and understands Zhong Jia Securities Limited will assess whether the Client has adequate knowledge on

derivative products according to the information the Client provided. 客戶將會/或會進行買賣任何衍生産品，並知悉及明白中佳證券有限公司將根據以下的資料以評估客

戶是否對衍生工具產品有認識。

口 Client had undergone training or attended courses related to derivative products; and/ or 客戶曾接受有關衍生産品的培訓或修讀相關課程; 及／或

口 Client has current or past work experience related to derivative products; and/ or 客戶現時戓過去擁有與衍生産品有關的工作經驗; 及／或

口 Client has executed 5 or more transactions in derivative products in the past 3 years, e.g. Derivative Warrants, Callable Bull/Bear Contracts, Stock Options, Futures & Options,

and Exchange Traded Funds, etc. 客戶於過去三年內曾執行5次或以上有關衍生産品的交易，例如: 衍生權證、牛熊證、股票期權、期貨及期權、及交易所買賣基

金等。

口 Client DOES NOT WISH to trade any derivative products 客戶不會買賣任何衍生産品。

Confirmed & Signed by Client 客戶確認及簽署 :

1.________________________ (Main Account Holder 主要戶口持有人)

2. ________________________ (Joint Account Holder 聯名戶口持有人)

9. Signing Arrangement 簽名安排 (for Joint Account only 只適用於聯名帳戶)

The Account can be operated, including fund withdrawal, under the instruction of (please tick the appropriate box):

此帳戶可根據以下指示方式操作，包括資金提取 (請在適當空格加“✓”):

口 Either one of the account holders; or 任何一位帳戶持有人的指示 ; 或口 Both account holders 兩位帳戶持有人的指示

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10. Other Services 其他服務

口 Client consents to receive “Password” by E-mail for electronic trading (if applicable) 同意經電郵收取“密碼” 用作電子交易(如適用)

11. Settlement Account Information (for fund withdrawal) 結算帳戶資料 (用作資金提取)

A/C holder must bear the same name as this trading account 銀行帳戶持有人名稱必須與本交易帳戶持有人相同

Currency 貨幣 Name of Bank 銀行名稱 Account No. 帳戶號碼 Name of Account Holder 帳戶持有人名稱

HKD 港幣

USD 美元

CNY 人民幣

Other 其他 (Please specify 請明) :__________


12. Disclosure of Identity 相關身份披露

Are you a director, an employee or a representative of an intermediary licensed/

registered under the Securities and Futures Ordinance?

閣下是否為《證券及期貨條例》之下持牌/ 註冊的中介人的董事，僱員或代表?

口 No 否

口 Yes*, I am a director/ an employee 口 Yes*, I am a registered representative

本人是董事／僱員本人是持牌代表

* Please specify the name of the intermediary and your CE. No. :

請列出該中介人名稱及閣下的中央編號：

___________________________________________________ * Please attach a consent letter of account opening from the intermediary.

請附上該中介人發出之開戶同意書。

Are you a director, an employee or a representative of an intermediary licensed/registered

under the Securities and Futures Ordinance?

閣下是否為《證券及期貨條例》之下持牌/ 註冊的中介人的董事，僱員或代表?

口 No 否

口 Yes*, I am a director/ an employee 口 Yes*, I am a registered representative

本人是董事／僱員本人是持牌代表

* Please specify the name of the intermediary and your CE. No. :

請列出該中介人名稱及閣下的中央編號：

___________________________________________________ * Please attach a consent letter of account opening from the intermediary.

請附上該中介人發出之開戶同意書。

Are you an employee or a relative of any director, employee or representative of Zhong

Jia Securities Limited or its group companies?

閣下是否中佳證券有限公司或其集團公司之僱員或與任何董事、職員或代表有親

屬關係?

口 No 否

口 Yes, the name of the director, employee or representative and

relationship with him/her

是，請列出該董事、職員或代表之名稱及與此人之關係

__________________________________________________

Are you an employee or a relative of any director, employee or representative of Zhong

Jia Securities Limited or its group companies?

閣下是否中佳證券有限公司或其集團公司之僱員或與任何董事、職員或代表有親

屬關係?

口 No 否

口 Yes, the name of the director, employee or representative and

relationship with him/her

是，請列出該董事、職員或代表之名稱及與此人之關係

___________________________________________________

Are you, your spouse, child, or parent entrusted or has been entrusted with a prominent

public function, which includes a head of state, head of government, judicial or military

official, senior executive of a state-owned corporation and an important political party

official?

閣下、配偶、子女戓父母，是否擔任重要公職，包括國家元首、政府首長、司法

或軍事官員、國有企業高級行政人員及重要政黨幹事?

口 No 否

口 Yes, please specify: 是，請說明: ____________________________________

Are you, your spouse, child, or parent entrusted or has been entrusted with a prominent

public function, which includes a head of state, head of government, judicial or military

official, senior executive of a state-owned corporation and an important political party

official?

閣下、配偶、子女戓父母，是否擔任重要公職，包括國家元首、政府首長、司法

或軍事官員、國有企業高級行政人員及重要政黨幹事?

口 No 否

口 Yes, please specify: 是，請說明: ___________________________________

13. Are you the ultimate beneficial owner of the account? 閣下是否此戶口最終權益擁有人?

口 Yes 是

口 No, Please provide the information of the ultimate beneficial owner as stated below: 不是，請提供戶口最終權益擁有人資料如下

Name in Chinese 中文姓名 Name in English 英文姓名

Date of Birth 出生日期 Sex 性別

ID No. (or Passport No. and Country of issue) 身份證號碼 (或護照號碼及簽發國家) Nationality 國籍


Permanent Address (if different from the above stated, in English BLOCK letters and in Chinese) 永久地址 (如與上述不同，請以中英文正楷填寫)

14. Authorized Person 獲授權人

Has any person been authorized to give instructions in relation to all transactions? 閣下是否已授權任何人士作出有關交易指令?

口 No 否

口 Yes, please refer to attached Letter of Authorization and Information Statement of Authorized Person.

是，請參閱附上之授權書及獲授權人資料表。

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15. Disclosure of Group Related Margin Clients* 關連保證金客戶聲明* (for Margin Account only 只適用於保證金帳戶)

For the purpose of complying with the requirements of Financial Resources Rules (“FRR”) in regards to “Group of Related Margin Clients”*,

I/We ______________________________________ (A/C No._______________________) hereby declare that:

I/We 口 DO NOT HAVE/口 HAVE related margin account(s) with Zhong Jia Securities Limited. If you have, please state:

為符合財政資源規則下有關一組關連保證金客戶*的要求，

本人／吾等_________________________________（帳戶號碼：_____________________ ) 特此聲明：

本人/吾等口沒有/ 口持有任何關連保證金戶口於中佳證券有限公司。如有，請說明:

Account No. 帳戶號碼 Name 名稱 Relationship 關係

* “Group of Related Margin Clients” as defined in FRR means: (a) where it is a group of two margin clients, one is the spouse of the other; (b) where one or more of the margin clients

are corporations, one is in control, either alone or with his/her spouse, of 35% or more of the voting rights of that other margin client or each of the other margin clients; or (c) where

the margin clients are corporations, they are members of the same group of companies.

* 財政資源規則所定義的「一組關連保證金客戶」是指：(a) 如該組只有 2 名保證金客戶，其中一名保證金客戶是另一名的配偶；(b) 如該等保證金客戶中有一名或多於

一名是法團，其中一名保證金客戶單獨或與其配偶控制其餘的一名或每名保證金客戶的 35％或以上的表決權；或 (c) 如該等保證金客戶均為法團，該等保證金客戶是同

一公司集團的成員。

16. Declaration and Acknowledgment 聲明及確認

Prior to signing this Account Opening Form, please: 於簽署此開戶表格前，敬請：

(i) note that all transactions to be concluded with or through Zhong Jia Securities Limited (ZJ) shall be subject to the terms and conditions of the Client Agreement (as defined

below); and 注意所有與中佳證券有限公司（“貴公司”）完成或透過貴公司進行之交易均受客戶協議（定議請參閱下文）之條件及條款所限制；及

(ii) read the Client Agreement (including Risk Disclosure Statement) which you have been provided in a language (English or Chinese) of your choice carefully, ask questions and take independent advice if you so wish. 細閱已按照閣下所選擇的語言（英文或中文）而提供予閣下的客戶協議（包括風險披露聲明），提出問題及徵求獨立的意

見（如閣下有此意願）。

I/We declare and acknowledge that: 本人/吾等聲明及確認 :

1. I / We acknowledge my / our receipt of the Client Agreement of ZJ (including all sections thereunder and appendices thereto), the Risk Disclosure Statement, the Client Information Statement, the Account Opening Form and any other agreements or documents related to the opening of the account(s), whenever applicable (collectively the “Client Agreement”) and confirm that the Client Agreement (including Risk Disclosure Statement) were provided to me / us in a language (English or Chinese) of my / our choice and I / we was / were invited to read the Client Agreement (including Risk Disclosure Statement) and General Knowledge on Derivatives Course (if applicable) carefully, ask questions and take independent advice if I /we so wish. 本人/吾等確認已收妥貴公司之客戶協議（包括協議所有部份及附錄）、風險披露聲明、客戶資料聲明、

開戶表格及其他與是次開戶有關的協議及文件（如適用）（合稱「客戶協議」）及確認客戶協議（包括風險披露聲明）是按照本人/吾等所選擇的語言（英文或

中文）而提供，並已邀請本人/吾等閲讀該客戶協議（包括風險披露聲明）及一般衍生工具知識課程（如適用），提出問題及徵求獨立的意見（如本人/吾等有此

意願）。

2. I / We confirm that I / we have carefully read, fully understood and accepted all the terms and provisions contained in the Client Agreement (including Risk Disclosure Statement) and shall be bound by the Client Agreement (including Risk Disclosure Statement) as it may be amended from time to time. 本人/吾等確認本人/吾等已仔細閲

讀，充分理解並接受載於客戶協議內（包括風險披露聲明）的所有條款及規定，並同意遵守客戶協議（包括風險披露聲明）可能會不時修訂的所有條款及規

定。

3. [For Margin Account] I/We have read and understood the content of the Authorization for Client Securities (as per ANNEX 1), i.e. the “Standing Authority” for Margin Account

and am/are aware of the relevant risks in providing you with such authority. I/We understand that such authority will be renewed annually under the regulatory requirement

and agree to be bound by its terms. [適用於保證金帳戶] 本人/吾等已閱讀及明白於附件一之「客戶證券授權書」的內容，即就保證金帳戶作出的“常設授權“，同

時亦了解其相關的風險就所作出的授權。本人/吾等明白此授權會按照監管要求下每年續期，並同意接受該授權書內的條款所約束。

4. I / We confirm that I / we have carefully read, fully understood and accepted the explanations contained in “the Definitions of Risk Tolerance Assessment” 本人/吾等確認本人/吾等已仔細閲讀，充分理解並接受載於「風險承受能力評估的說明」的釋義。

5. I / we further acknowledge and agree that: 本人/吾等進一步確認及同意：

a. in the event of ZJ default and me / us having incurred a loss as a result thereof, the liability of the Investor Compensation Fund established under the Securities and

Futures Ordinance (where applicable) will be restricted to the extent provided for therein, and 若因貴公司之失誤而導致本人/吾等蒙受損失，賠償責任將限於

根據證券及期貨條例成立之投資者賠償基金規定的範圍內（如適用）；及

b. where securities are deposited with ZJ or purchased pursuant to the Client Agreement and held outside Hong Kong, I / we may not be afforded equivalent protection in respect of those securities as that afforded under Hong Kong law and I / we may not have the same right as I / we have in respect of securities held in Hong Kong. 假若證券寄存於貴公司或根據客戶協議買入並於香港以外持有，本人/吾等便可能不能享有香港法例給予該等證券的同等保障，以及可能不能享有如同在

香港持有該等證券的相同權利。

6. I/We represent that the information contained in this Supplementary Information for Client Profile is true, complete and correct. ZJ is entitled to rely fully on such information and representations for all purposes, until ZJ receive notice in writing from me/us of any changes. If there are any changes in respect of the information contained in this information above, I/We undertake to inform ZJ promptly. ZJ is authorized at any time to contact anyone for the purpose of verifying the information provided. 本人/吾等

聲明本客戶補充資料上所述的資料為真實、完整及正確。除貴公司收到本人/吾等書面通知更改，貴公司有權依賴上述的資料及聲明作任何目的。如上述所提供

的資料有任何更改，本人/吾等承諾將立即通知貴公司。貴公司獲授權於任何時間聯絡有關人士核對上述資料。

7. [ Circular relating to Personal Data (Privacy) Ordinance ] [ 有關《個人資料（私隱）條例》之客戶通知書 ]

I/We confirm that I/we have already perused and understood Zhong Jia Securities Limited (“ZJ”)’s Privacy Policy and Personal Information Collection Statement. I/We confirm my/our consent given to ZJ to retain and use my/our personal data for the purposes as set out in ZJ’s Privacy Policy and Personal Information Collection Statement, which

can be accessed on ZJ’s website: http://www.zjsec.com.hk/. I/We confirm my/our understanding that ZJ’s Privacy Policy and Personal Information Collection Statement could be revised and updated by ZJ from time to time without prior notice to me/us and that I/we should access the same to review any updates from time to time. I/We acknowledge that I/we could obtain updated copies of ZJ’s Privacy Policy and Personal Information Collection Statement by calling ZJ’s Customer Service hotline at 2115 8467 anytime during office hours. To access or update my/our personal data held by ZJ or to request ZJ not to use such personal data in direct marketing, I/we should write to ZJ’s Data Protection Officer at Room 9, 8/F, One Island South, 2 Heung Yip Street, Hong Kong.

本人/吾等確認本人/吾等已細閱及明白中佳證券有限公司（中佳）私隱政策及個人資料收集聲明。本人/吾等確認本人/吾等同意中佳收集及使用本人/吾等的個

人資料用於中佳私隱政策及個人資料收集聲明所列明的相關用途，並可透過中佳網址(http://www.zjsec.com.hk/) 查閱。本人/吾等確認本人/吾等已明白中佳私隱政策及個人資料收集聲明可不時作出修訂及更新，並且不會就此作出另行通知，本人/吾等亦應不時查閱其更新的版本。本人/吾等已得悉本人/吾等可於辦

公時間內致電中佳客戶服務熱線: 2115 8467 索取最新的中佳私隱政策及個人資料收集聲明的副本。如欲查閱或更新中佳所收集的個人資料，或要求中佳不再使

用本人/吾等的個人資料作直接促銷，本人/吾等應以書面聯絡中佳的資料保護主任，地址: 香港香葉道 2 號 One Island South 大廈 8 樓 9 室。

I/We confirm that I/we have been notified that my/our personal data inclusive of my/our name(s), telephone number(s), e-mail address(es) and address(es) are intended to be used in direct marketing, the details of which are set out in ZJ’s Privacy Policy and Personal Information Collection Statement, which can be accessed on ZJ’s website:

http://www.zjsec.com.hk/, but that such use of my/our said personal data in direct marketing could not take place without my/our consent.

http://www.zjsec.com.hk/http://www.zjsec.com.hk/http://www.zjsec.com.hk/

5

本人/吾等確認本人/吾等已被通知本人/吾等的個人資料包括本人/吾等的姓名、電話號碼、電郵地址及地址將作直接促銷，有關詳情載於中佳私隱政策及個人資

料收集聲明，並可透過中佳網址 (http://www.zjsec.com.hk/) 查閱。在未得到本人/吾等同意之前，中佳並不能使用本人/吾等的個人資料作直接促銷。

I/We understand that I/we should sign at the end of this Notice to indicate that I/we have perused, understood and agreed with the contents of this Not ice and to indicate

my/our agreement to the aforesaid use of my/our said personal data in direct marketing.

本人/吾等明白本人/吾等應在本通告下方簽署以表明本人/吾等已細閱、明白及同意本通告的內容，並表明本人/吾等同意上述有關使用本人/吾等的個人資料作

直接促銷。

Should I/we find the aforesaid use of my/our said personal data in direct marketing not acceptable, I/we would indicate my/our objection before signing by ticking ☑ below.

如本人/吾等不接受本人/吾等的個人資料用於直接促銷，本人/吾等將於簽署前在下列空格加上☑以茲反對。

I/We do not wish to receive ongoing marketing information/materials from ZJ and I/we do not consent to ZJ’s retention and use of my/our personal data in direct marketing.

本人/吾等不願意收取中佳推廣資訊/刊物及本人/吾等不同意中佳保留及使用本人/吾等的個人資料作直接促銷。

Name of Client(s) 客戶名稱

1.__________________________ (Main Account Holder 主要戶口持有人)

2.__________________________ (Joint Account Holder 聯名戶口持有人)

Signature of Client(s) 客戶簽署

1._____________________________ (Main Account Holder 主要戶口持有人)

2._____________________________ (Joint Account Holder 聯名戶口持有人)

Date 日期 : _____ day (日) of ____ month (月) of______ year (年)

in the presence of 見證人:

________________________________________________

Name of Witness# 見證人名稱#

________________________________________________

Profession/Occupation 專業/職業

________________________________________________

Name of Company 公司名稱

________________________________________________

Company Address 公司地址

__________________________________________ Signature of Witness 見證人簽署


# Witness should be a licensed or registered person, an affiliate of a licensed or registered person, a Justice of the Peace, or a professional person such as a branch manager of a bank, certified public accountant, lawyer, notary public, or an officer of an embassy, consulate or high commission of the country of issue of documentary verification of identity. 見證人應為持牌或註冊人士、持牌或註冊人士的聯繫人士、太平紳士或專業人士，例如銀行分行經理、執業會計師、律師、公證人，或發出身份

核實文件的國家的大使館、領事館或高級專員公署的人員。

http://www.zjsec.com.hk/

6

ACCOUNT EXECUTIVE’S DECLARATIONS 客戶主任聲明

I hereby confirm that: 本人在此確認：

☐ I have witnessed the signature and inspected the original identity documents of the above-named client. 本人已核查上述客戶之身份證明文件之原

本，並見證上述客戶之簽名。

☐ The client has been provided with the Client Agreement (including Risk Disclosure Statement) in the language of the client’s choice (English or Chinese); and the client has been invited to read the Client Agreement (including Risk Disclosure Statement), ask questions and take independent advice if the client so wishes. 客戶已被提供按照其所選擇的語言（英文或中文）的客戶協議（包括風險披露聲明），本人並且已邀請客戶閲讀該客戶協議

（包括風險披露聲明），提出問題及徵求獨立的意見（如閣下有此意願）。

☐ I have already explained to the client that if the client is currently employed by any registered institution or licensed corporation to carry on regulated activities, the client is required to provide ZJ a written consent from his / her employer in support of this account opening. 本人已向客戶解釋，假若

客戶現受僱於任何從事受規管活動之註冊機構或持牌公司，客戶必須向本公司提供其僱主就是次開納帳戶所發出的同意書。

☐

The client has been provided with “the Definitions of Risk Tolerance Assessment” in the language of the client’s choice (English or Chinese); and the

client has been invited to read the explanation contained in “the Definitions of Risk Tolerance Assessment”, ask questions and take independent advice if the client so wishes. 客戶已被提供按照其所選擇的語言（英文或中文）的「風險承受能力評估的說明」，本人並且已邀請客戶閲讀該「風險

承受能力評估的說明」的釋義，提出問題及徵求獨立的意見（如閣下有此意願）。

Signed by licensed representative 持牌代表簽署

CE Number 中央編號

Name of licensed representative (in block letters) 持牌代表名稱 (正楷)

Date 日期

_______________________________________________

Name of Responsible Officer 負責人員姓名

Acknowledged and Accepted by

Zhong Jia Securities Limited 經由中佳證券有限公司

承認及接納

____________________________________________ Signature of Responsible Officer 負責人員簽署


7

Checking List - Completed by AE 查核表格 – 由經紀填寫

1. □ Face-to-face account opening 面對面方式開戶 □ NON face-to-face account opening 非面對面方式開戶

2. Commission Rate/ Set-up Fee 佣金收費/ 設立費

(i) □Cash (Phone Trading) 現金帳戶(電話交易): □_______ % with HK$_____min.最低

(ii) □Online Cash 電子現金帳戶: □_______ % with HK$_____min.最低

(iii) □Margin (Phone Trading) 孖展帳戶(電話交易): □_______ % with HK$_____min.最低

(iv) □Online Margin 電子孖展帳戶: □_______ % with HK$_____min.最低

Documents 文件 Checking 查核

(A) Account Opening Documents 帳戶開戶文件

1. Account Opening Application Form 開戶申請表格

2. Copy of Hong Kong Identity Card(s) or Unexpired Government issued Identification Document Card(s) or Passport(s) of all account holder(s) (and beneficiary

owner if applicable)

所有戶口持有人之香港身份證明文件或有效身份證明文件或護照之副本(及受益人如適用)

3. Copy of valid Residential Address Proof within the latest 3 months

最近三個月內之有效住址證明文件

4. Consent letter of account opening from the intermediary 由持牌中介人發出的開戶同意信

5. A cheque issued by a Hong Kong licensed bank with a sum not less than HK$10,000 made payable to "Zhong Jia Securities Limited” (if applicable)在香港持

牌銀行開立的帳戶所簽發的支票，該支票需符合數額不得少於 HK$10,000，抬頭為「中佳證券有限公司」 (如適用)

6. Original ML/ TF Risk Assessment Form 反洗錢和反恐怖主義融資政策評估表格

7. Supporting Documents of Witness (if NON face-to-face account opening) 見證人證明文件(如非面對面方式開戶)

8. Self-Certification Form – Individual (CRS-I (HK)) 自我證明表格-個人 (CRS-I (HK))

9. Standing Authority under the Securities and Futures (Client Securities) Rules 根據《證券及期貨(客戶證券)規則》作出的常設授權

(B) Authorization of Third Party Trading (if applicable) 第三者授權交易 (如適用)

1. Form of authorization of third party trading 第三者授權表格

2. HKID / Passport Copy of all Authorized Person(s) )

所有獲授權人士之香港身份證明文件或有效身份證明文件或護照之副本

3. Copy of valid Residential Address Proof within the latest 3 months of Authorized Person(s)

所有獲授權人士之最近三個月內之有效住址證明文件

4. Consent letter to act as authorized person from the intermediary 由持牌中介人發出的成為獲授權人同意信

Completed by AE:

AE Code Name of AE Signature Date Remarks (if any)

Completed By Compliance

1. Licence Registration Checking : □ No suspicion found □ Suspicion found: □ Account Holder(s) □ Authorized Person(s)

2. AML Checking: □ No suspicion found □ Suspicion found, details: _____________________________

3. PEP Checking: □ No suspicion found □ Suspicion found, details: _____________________________

Checked By:______________________ Date: ____________________

Responsible Officer’s Decision 負責人員決定

Restricted Products/ Markets 受限制產品/ 市場:

□ Main Board 主板 Reason 原因:______________________________________

□ GEM Board 創業板 Reason 原因:____________________________________

□ Derivative Products 衍生產品 Reason 原因:____________________________

□ Others 其他 Reason 原因:__________________________________________

Approved By RO 由負責人員批核:

______________________________________________

Name of Responsible Officer 負責人員姓名

______________________________________________

Signature of Responsible Officer 負責人員簽署

Date 日期 : ____day (日) of _____ month (月) of_____ year (年)

Signed by Settlement: ________________________ Date of Opening: _______________________

ANNEX 1 附件一

Standing Authority under the Securities and Futures (Client Securities) Rules

根據《證券及期貨(客戶證券)規則》作出的常設授權

To: Zhong Jia Securities Limited 中佳證券有限公司 Room 9, 8/F, One Island South, 2 Heung Yip Street, Hong Kong

This authority covers the securities or securities collateral received or held by Zhong Jia Securities Limited and/or any

subsidiaries or affiliates (Collectively called “Zhong Jia”) on my/our behalf. Unless otherwise defined, all the terms used

in this Authorization shall have the same meanings as defined in the Securities and Futures Ordinance and the Securities

and Futures (Client Securities) Rules as amended from time to time. 本授權書是關於中佳證券有限公司及／或任何有關的附屬或關聯公司（統稱為「中佳」）代表本人／吾等接收或持有的證券或證券抵押品。除另有說明外，在本授權書內所有用語的意思與經不時修訂的《證券及期貨條例》及《證券及期貨(客戶證券)規則》內所定義的意思相同。 I/We authorize Zhong Jia to: 本人／吾等授權中佳： 1. deposit any of my/our securities collateral with an authorized financial institution as collateral for financial

accommodation provided to Zhong Jia; or 將本人／吾等的任何證券抵押品存放於認可的財務機構，作為提供予中佳的財務通融的抵押品；或

2. deposit any of my/our securities collateral with 將本人／吾等的任何證券抵押品存放於 a recognized clearing house; or 一家認可的結算所；或 (i) another intermediary licensed or registered for dealing in securities,

獲發牌或獲註冊進行證券交易的另一中介人， as collateral for the discharge and satisfaction of settlement obligations and liabilities.

作為中佳履行交收義務與責任的抵押品。 Zhong Jia may do any of these things without giving me/us notice. 貴公司可毋須通知本人／吾等而進行上述各項。 Zhong Jia are accountable to me/us for the return of equivalent securities deposited under this authority after full

repayment by me/us of all my/our outstanding loans under the facility. 當本人／吾等全數償還信貸安排下所有未清償的貸款後，中佳須負責向本人／吾等歸還在此授權下存放的相等證券。

I/We understand that a third party may have a lien or charge on my/our securities or securities collateral, which Zhong Jia

must satisfy before returning my/our securities or securities collateral to me/us. 本人／吾等明白，本人／吾等的證券或證券抵押品可能受制於第三者之留置權或押記，中佳必須先行了結有關留置權或押記，方可將本人／吾等的證券或證券抵押品歸還本人／吾等。

I/We am/are aware that there is risk if I/we authorize Zhong Jia to repledge my/our securities collateral for financial

accommodation or deposit my/our securities collateral for the discharge and satisfaction of settlement obligations and

liabilities. 本人／吾等知悉，本人／吾等若授權中佳再質押本人／吾等的證券抵押品以取得財務通融，或授權中佳存放本人／吾等的證券抵押品作為中佳履行交收義務與責任的抵押品，如此授權是帶有風險的。

I/We acknowledge and agree that the authority shall be valid for not more than 12 months and will expire at 30 June

every year (the “Expiry Date”). I/We understand that Zhong Jia will give me/us a written notice at least 14 days before

the Expiry Date to renew this authority, and if Zhong Jia does not receive any objection to such renewal from me/us in

writing before the Expiry Date, this authority shall be deemed to be renewed for next 12 months on a continuing basis.

本人／吾等確認並同意，此授權的有效期不多於12 個月，並將於每年6月30日（「屆滿日」）屆滿。本人／吾等明白，中佳將在屆滿日前至少14日給予本人／吾等有關此授權的續期通知書，如若中佳在屆滿日前沒有收到本人／吾等以書面形式對此續期提出的任何反對，則此授權將被視為持續地為未來12個月續期。

In the event of any discrepancy between the English and Chinese version of this Authorization, I/we agree that the

English version shall prevail.

若本授權書的英文版本及中文版本在內容上有任何歧異，本人／吾等同意以英文版本為準。 I/We have read and understood the contents of this Authorization and agree to be bound by its terms. 本人／吾等已閱讀及明白本授權書的內容，並同意受本授權書的內容約束。

Names of Client(s) and A/C No. 客戶姓名及帳戶號碼

Signatures of Client(s) 客戶簽署 Date 日期

Form W-8BEN(Rev. July 2017)

Department of the Treasury Internal Revenue Service

Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)

▶ For use by individuals. Entities must use Form W-8BEN-E. ▶ Go to www.irs.gov/FormW8BEN for instructions and the latest information.

▶ Give this form to the withholding agent or payer. Do not send to the IRS.

OMB No. 1545-1621

Do NOT use this form if: Instead, use Form:

• You are NOT an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E

• You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . W-9

• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S. (other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI

• You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4

• You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY

Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence.

Part I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial owner 2 Country of citizenship

3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

City or town, state or province. Include postal code where appropriate. Country

4 Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate. Country

5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)

7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)

Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 I certify that the beneficial owner is a resident of

% rate of withholding on (specify type of income):

within the meaning of the income tax

treaty between the United States and that country. 10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph

of the treaty identified on line 9 above to claim a

.

Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:

Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:

• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself for chapter 4 purposes,

• The person named on line 1 of this form is not a U.S. person,

• The income to which this form relates is:

(a) not effectively connected with the conduct of a trade or business in the United States,

(b) effectively connected but is not subject to tax under an applicable income tax treaty, or

(c) the partner’s share of a partnership's effectively connected income,

• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country, and

• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.

Sign Here

▲

Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)

Print name of signer Capacity in which acting (if form is not signed by beneficial owner)

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 7-2017)


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


1

Self-Certification Form – Individual (CRS-I (HK))

自我證明表格-個人(CRS-I (HK))

Instructions 指示

Please read the following instructions before completing this form 請在填寫本表格前細閱以下指示：

Why are we asking you to complete this form? 為何我們要求您填寫本表格？

To help protect the integrity of tax systems, governments around the world are introducing a new information-gathering and reporting requirement for financial institutions. This is known as the Common Reporting Standard (the "CRS").

Under the CRS, we are required to determine where you are a "tax resident" (this will usually be where you are liable to pay income taxes). If you are a tax resident outside the jurisdiction where your account is held, we may need to give the national tax authority this information, along with information relating to your accounts. That may then be shared between different jurisdictions' tax authorities.

Completing this form will ensure that we hold accurate and up to date information about your tax residency.

If your circumstances change and any of the information provided in this form becomes incorrect, please let us know immediately and provide an updated self- certification.

為維護稅制完整，全球各地政府現正推出適用於金融／財務機構的資料收集及匯報新規例，名為共同匯報標準（簡稱「CRS」）。

根據 CRS 規定，我們必須確定您的「稅務居住地」（這通常是您有義務繳納薪俸稅的國家／地區）。若您的稅務居住地有別於所持賬戶的司法管轄

區，我們可能需要將此情況及您的有關賬戶資料告知國家稅務機關，該等機關隨後或會將相關資料傳送給不同國家／地區的稅務機關。

填妥本表格可確保我們持有您正確及最新的稅務居住地資料。如您的情況有變，導致本表格內的任何資料不再正確，請立即告知我們，並提交一份

已更新的自我證明表格。

Who should complete the Self-Certification Form - Individual? 誰需填寫自我證明表格 - 個人?

Individual customers should complete this form. Sole trader customers should also complete this form with the owner's information.

If you need to self-certify on behalf of an entity (which includes businesses, trusts and partnerships), complete a "Self-Certification Form - Entity" (CRS-E). Similarly, if you are a controlling person of an entity, complete a "Self-Certification Form m - Controlling Person" (CRS-CP).

For joint account holders, each individual will need to complete a separate form.

Even if you have already provided information in relation to the United States Government's Foreign Account Tax Compliance Act (FATCA), you may still need to provide additional information for the CRS as this is a separate regulation.

個人客戶須填寫本表格。獨資業務客戶亦須以擁有人的資料填寫本表格。

如您需代表實體（包括企業、信託和合夥）作自我證明，請填寫「自我證明表格 - 實體」(CRS-E)。同樣地，如您是實體的控權人，請填寫「自我證

明表格 - 控權人」(CRS-CP)。

每名聯名賬戶持有人須分別填寫一份表格。

即使您已就美國政府《外國賬戶稅務合規法案》（簡稱「FATCA」）提供所需的資料，您仍可能需就 CRS 提供額外資料，因為兩者為獨立的規例。

Where to go for further information? 如何獲取更多資訊？

The Organization for Economic Co-operation and Development ("OECD") has developed the rules to be used by all governments participating in the CRS and these can be found on the OECD's Automatic Exchange of Information ("AEOI") website, www.oecd.org/tax/automatic-exchange/.

Please also visit the website of the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region that sets out information relating to the implementation of AEOI in Hong Kong: http://www.ird.gov.hk/eng/tax/dta_aeoi.htm. Meaning of terms and expressions used in this form (e.g. "account holder" and "reportable account") may be found under section 50A of the Inland Revenue Ordinance (Cap. 112).

If you have any questions on how to define your tax residency status, please visit the OECD website, www.oecd.org/tax/automatic-exchange/ or speak to your tax advisor as we are not allowed to give tax advice.

經濟合作與發展組織（簡稱「經合組織」）已制訂規則，供參與 CRS 的所有政府使用，並載於經合組織的自動交換資料（簡稱「 AEOI 」）網

站 www.oecd.org/tax/automatic-exchange/ 。

另請參閱香港特別行政區政府稅務局的網站了解香港實施 AEOI 的詳情： www.ird.gov.hk/chi/tax/dta_aeoi.htm. 有關本表格內所用詞彙的涵義（例

如：「賬戶持有人」和「須申報賬戶」），請參閱《稅務條例》（第 112 章）第 50A 條。

如您對判定您的稅務居民身分有任何疑問，請瀏覽經合組織網站 www.oecd.org/tax/automatic-exchange/ 或諮詢您的稅務顧問。請恕我們不能提供稅

務意見。

http://www.oecd.org/tax/automatic-exchange/http://www.ird.gov.hk/eng/tax/dta_aeoi.htmhttp://www.oecd.org/tax/automatic-exchange/http://www.ird.gov.hk/chi/tax/dta_aeoi.htmhttp://www.oecd.org/tax/automatic-exchange/


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


2

Important Notes 重要提示

This is a self-certification form provided by an account holder to Zhong Jia Securities Limited (“ZJ Securities”) for the purpose of automatic exchange of financial account information. The data collected may be transmitted by ZJ Securities to the Inland Revenue Department for transfer to the tax authority of another jurisdiction. 這是由賬戶持有人向中佳證券有限公司「中佳證券」提供的自我證明表格，以作自動交換財務賬戶資料用途。中佳證券可把

收集所得的資料交給稅務局，稅務局會將資料轉交到另一稅務管轄區的稅務當局。

An account holder should report all changes in his/her tax residency status to ZJ Securities. 如賬戶持有人的稅務居民身分有所改變，應盡快將所有變

更通知中佳證券。

All parts of the form must be completed (unless not applicable or otherwise specified). If space provided is insufficient, continue on additional sheet(s). Information in fields/parts marked with an asterisk (*) are required to be reported by the reporting financial institution to the Inland Revenue Department. 除不適用或特別註明外，必須填寫這份表格所有部分。如這份表格上的空位不夠應用，可另紙填寫。在欄／部標有星號（*）的項目為中佳證券

須向稅務局申報的資料

Part 1: Identification of Individual Account Holder 第 1 部：個人賬戶持有人的身分識辨資料

(For joint or multiple account holders, complete a separate form for each individual account holder.

對於聯名賬戶或多人聯名賬戶，每名個人賬戶持有人須分別填寫一份表格。 )

Note 注意： Please tick where applicable. 請在適當的地方加上剔號。

Name of Account Holder

賬戶持有人的姓名

Title 稱謂：□Mr 先生 □Mrs 太太 □Miss 小姐 □Ms 女士 □Other 其他___________

*Last Name or Surname 姓氏 *First or Given Name 名字 *Middle Name(s) 中間名

Business Name (Sole Traders Only) 公司名稱（只適用於獨資業務）

Hong Kong Identity Card or Passport Number

香港身分證或護照號碼

Current Residence Address

現時住址

(e.g. Suite, Floor, Building, Street, District 例如：室、樓層、大廈、街道、地區 )

*City 城市

(e.g. Province, State 例如：省、州 ) *Country 國家

Post Code/ZIP Code 郵政編碼／郵遞區號碼

Mailing Address 通訊地址 (Complete if

different to the above current residence

address 如通訊地址與上述現時住址不

同，填寫此欄 )


*City 城市



*Date of Birth 出生日期 (dd/mm/yyyy 日／月／年 )


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


3

Part 2: Jurisdiction of Residence and Taxpayer Identification Number or its Functional Equivalent ("TIN") *

第 2 部 : 居留司法管轄區及稅務編號或具等同功能的識辨編號(以下簡稱「稅務編號」 ) *

Complete the following table indicating 提供以下資料，列明:

(a) each jurisdiction where the account holder is a resident for tax purposes; and 賬戶持有人的居留司法管轄區，亦即賬戶持有人的稅務管轄區; 及

(b) the account holder's TIN for each jurisdiction indicated. 該居留司法管轄區發給賬戶持有人的稅務編號。

If the account holder is a tax resident of Hong Kong, the TIN is the Hong Kong Identity Card Number (HKID). 如賬戶持有人是香港稅務居民，稅務編號是賬戶

持有人的香港身份證號碼。

If a TIN is unavailable, provide the appropriate reason A, B or C 如沒有提供稅務編號，必須填寫合適的理由 A, B 或 C:

# Reason A - The jurisdiction where the account holder is a resident for tax purposes does not issue TINs to its residents.

理由 A - 賬戶持有人的居留司法管轄區並沒有向其居民發出稅務編號。

Reason B - The account holder is unable to obtain a TIN. Explain why the account holder is unable to obtain a TIN if you have selected this reason.

理由 B - 賬戶持有人不能取得稅務編號。如選取這一理由，解釋賬戶持有人不能取得稅務編號的原因。

Reason C - TIN is not required. Select this reason only if the authorities of the jurisdiction of residence do not require the TIN to be disclosed.

理由 C - 賬戶持有人毋須提供稅務編號。居留司法管轄區的主管機關不需要賬戶持有人披露稅務編號。

Jurisdiction of

Residence

居留司法管轄區

TIN

稅務編號

#Enter Reason A, B or C if no TIN is

available

如沒有提供稅務編號，填寫理由 A,B

或 C

Explain why the account holder is unable to obtain

a TIN if you have selected Reason B

如選取理由 B，解釋賬戶持有人不能取得稅務編

號的原因

(1)

(2)

(3)

Part 3: Declarations and Signature 第 3 部:聲明及簽署

I acknowledge and agree that (a) the information contained in this form is collected and may be kept by the financial institution for the purpose of automatic exchange of financial account information, and (b) such information and information regarding the account holder and any reportable account(s) may be reported by the financial institution to the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which the account holder may be resident for tax purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112). 本人知悉及同意，財務機構可根據《稅務條例》（第

112 章）有關交換財務帳戶資料的法律條文，（a）收集本表格所載資料並可備存作自動交換財務帳戶資料用途及（b）把該等資料和關於帳戶持有人

及任何須申報帳戶的資料向香港特別行政區政府稅務局申報，從而把資料轉交到帳戶持有人的居留司法管轄區的稅務當局。

I certify that I am the account holder to sign for the account holder of all the account(s) to which this form relates. 本人證明，就與本表格所有相關的帳戶，

本人是帳戶持有人簽署本表格。

I undertake to advise ZJ Securities of any change in circumstances which affects the tax residency status of the individual identified in Part 1 of this form or causes the information contained herein to become incorrect, and to provide ZJ Securities with a suitably updated self-certification form within 30 days of such change in circumstances. 本人承諾，如情況有所改變，以致影響本表格第 1 部所述的個人的稅務居民身分，或引致本表格所載的資料不正確，本人

會通知中佳證券，並會在情況發生改變後 30 日內，向中佳證券提交一份已適當更新的自我證明表格。

I declare that the information given and statements made in this form are, to the best of my knowledge and belief, true, correct and complete. 本人聲明

就本人所知所信，本表格內所填報的所有資料和聲明均屬真實、正確和完備。

Signature 簽署

X Date (dd/mm/yyyy) 日期 (日／月／年):

Name 姓名

WARNING: It is an offence under section 80(2E) of the Inland Revenue Ordinance if any person, in making a self-certification, makes a statement that is misleading, false or incorrect in a material particular AND knows, or is reckless as to whether, the statement is misleading, false or incorrect in a material particular. A person who commits the offence is liable on conviction to a fine at level 3 (i.e. $10,000).警告: 根據《稅務條例》第 80(2E)條，如任何人在

作出自我證明時，在明知一項陳述在要項上屬具誤導性、虛假或不正確，或罔顧一項陳述是否在要項上屬具誤導性、虛假或不正確下，作出該項陳

述，即屬犯罪。一經定罪，可處第 3 級（即$10,000）罰款。


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


1

Self-Certification Form – Individual (CRS-I (HK))

自我證明表格-個人(CRS-I (HK))

Instructions 指示

Please read the following instructions before completing this form 請在填寫本表格前細閱以下指示：

Why are we asking you to complete this form? 為何我們要求您填寫本表格？

To help protect the integrity of tax systems, governments around the world are introducing a new information-gathering and reporting requirement for financial institutions. This is known as the Common Reporting Standard (the "CRS").

Under the CRS, we are required to determine where you are a "tax resident" (this will usually be where you are liable to pay income taxes). If you are a tax resident outside the jurisdiction where your account is held, we may need to give the national tax authority this information, along with information relating to your accounts. That may then be shared between different jurisdictions' tax authorities.

Completing this form will ensure that we hold accurate and up to date information about your tax residency.

If your circumstances change and any of the information provided in this form becomes incorrect, please let us know immediately and provide an updated self- certification.

為維護稅制完整，全球各地政府現正推出適用於金融／財務機構的資料收集及匯報新規例，名為共同匯報標準（簡稱「CRS」）。

根據 CRS 規定，我們必須確定您的「稅務居住地」（這通常是您有義務繳納薪俸稅的國家／地區）。若您的稅務居住地有別於所持賬戶的司法管轄

區，我們可能需要將此情況及您的有關賬戶資料告知國家稅務機關，該等機關隨後或會將相關資料傳送給不同國家／地區的稅務機關。

填妥本表格可確保我們持有您正確及最新的稅務居住地資料。如您的情況有變，導致本表格內的任何資料不再正確，請立即告知我們，並提交一份

已更新的自我證明表格。

Who should complete the Self-Certification Form - Individual? 誰需填寫自我證明表格 - 個人?

Individual customers should complete this form. Sole trader customers should also complete this form with the owner's information.

If you need to self-certify on behalf of an entity (which includes businesses, trusts and partnerships), complete a "Self-Certification Form - Entity" (CRS-E). Similarly, if you are a controlling person of an entity, complete a "Self-Certification Form m - Controlling Person" (CRS-CP).

For joint account holders, each individual will need to complete a separate form.

Even if you have already provided information in relation to the United States Government's Foreign Account Tax Compliance Act (FATCA), you may still need to provide additional information for the CRS as this is a separate regulation.

個人客戶須填寫本表格。獨資業務客戶亦須以擁有人的資料填寫本表格。

如您需代表實體（包括企業、信託和合夥）作自我證明，請填寫「自我證明表格 - 實體」(CRS-E)。同樣地，如您是實體的控權人，請填寫「自我證

明表格 - 控權人」(CRS-CP)。

每名聯名賬戶持有人須分別填寫一份表格。

即使您已就美國政府《外國賬戶稅務合規法案》（簡稱「FATCA」）提供所需的資料，您仍可能需就 CRS 提供額外資料，因為兩者為獨立的規例。

Where to go for further information? 如何獲取更多資訊？

The Organization for Economic Co-operation and Development ("OECD") has developed the rules to be used by all governments participating in the CRS and these can be found on the OECD's Automatic Exchange of Information ("AEOI") website, www.oecd.org/tax/automatic-exchange/.

Please also visit the website of the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region that sets out information relating to the implementation of AEOI in Hong Kong: http://www.ird.gov.hk/eng/tax/dta_aeoi.htm. Meaning of terms and expressions used in this form (e.g. "account holder" and "reportable account") may be found under section 50A of the Inland Revenue Ordinance (Cap. 112).

If you have any questions on how to define your tax residency status, please visit the OECD website, www.oecd.org/tax/automatic-exchange/ or speak to your tax advisor as we are not allowed to give tax advice.

經濟合作與發展組織（簡稱「經合組織」）已制訂規則，供參與 CRS 的所有政府使用，並載於經合組織的自動交換資料（簡稱「 AEOI 」）網

站 www.oecd.org/tax/automatic-exchange/ 。

另請參閱香港特別行政區政府稅務局的網站了解香港實施 AEOI 的詳情： www.ird.gov.hk/chi/tax/dta_aeoi.htm. 有關本表格內所用詞彙的涵義（例

如：「賬戶持有人」和「須申報賬戶」），請參閱《稅務條例》（第 112 章）第 50A 條。

如您對判定您的稅務居民身分有任何疑問，請瀏覽經合組織網站 www.oecd.org/tax/automatic-exchange/ 或諮詢您的稅務顧問。請恕我們不能提供稅

務意見。

http://www.oecd.org/tax/automatic-exchange/http://www.ird.gov.hk/eng/tax/dta_aeoi.htmhttp://www.oecd.org/tax/automatic-exchange/http://www.ird.gov.hk/chi/tax/dta_aeoi.htmhttp://www.oecd.org/tax/automatic-exchange/


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


2

Important Notes 重要提示

This is a self-certification form provided by an account holder to Zhong Jia Securities Limited (“ZJ Securities”) for the purpose of automatic exchange of financial account information. The data collected may be transmitted by ZJ Securities to the Inland Revenue Department for transfer to the tax authority of another jurisdiction. 這是由賬戶持有人向中佳證券有限公司「中佳證券」提供的自我證明表格，以作自動交換財務賬戶資料用途。中佳證券可把

收集所得的資料交給稅務局，稅務局會將資料轉交到另一稅務管轄區的稅務當局。

An account holder should report all changes in his/her tax residency status to ZJ Securities. 如賬戶持有人的稅務居民身分有所改變，應盡快將所有變

更通知中佳證券。

All parts of the form must be completed (unless not applicable or otherwise specified). If space provided is insufficient, continue on additional sheet(s). Information in fields/parts marked with an asterisk (*) are required to be reported by the reporting financial institution to the Inland Revenue Department. 除不適用或特別註明外，必須填寫這份表格所有部分。如這份表格上的空位不夠應用，可另紙填寫。在欄／部標有星號（*）的項目為中佳證券

須向稅務局申報的資料

Part 1: Identification of Individual Account Holder 第 1 部：個人賬戶持有人的身分識辨資料

(For joint or multiple account holders, complete a separate form for each individual account holder.

對於聯名賬戶或多人聯名賬戶，每名個人賬戶持有人須分別填寫一份表格。 )

Note 注意： Please tick where applicable. 請在適當的地方加上剔號。

Name of Account Holder

賬戶持有人的姓名

Title 稱謂：□Mr 先生 □Mrs 太太 □Miss 小姐 □Ms 女士 □Other 其他___________

*Last Name or Surname 姓氏 *First or Given Name 名字 *Middle Name(s) 中間名

Business Name (Sole Traders Only) 公司名稱（只適用於獨資業務）

Hong Kong Identity Card or Passport Number

香港身分證或護照號碼

Current Residence Address

現時住址


*City 城市



Mailing Address 通訊地址 (Complete if

different to the above current residence

address 如通訊地址與上述現時住址不

同，填寫此欄 )


*City 城市



*Date of Birth 出生日期 (dd/mm/yyyy 日／月／年 )


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


3

Part 2: Jurisdiction of Residence and Taxpayer Identification Number or its Functional Equivalent ("TIN") *

第 2 部 : 居留司法管轄區及稅務編號或具等同功能的識辨編號(以下簡稱「稅務編號」 ) *

Complete the following table indicating 提供以下資料，列明:

(a) each jurisdiction where the account holder is a resident for tax purposes; and 賬戶持有人的居留司法管轄區，亦即賬戶持有人的稅務管轄區; 及

(b) the account holder's TIN for each jurisdiction indicated. 該居留司法管轄區發給賬戶持有人的稅務編號。

If the account holder is a tax resident of Hong Kong, the TIN is the Hong Kong Identity Card Number (HKID). 如賬戶持有人是香港稅務居民，稅務編號是賬戶

持有人的香港身份證號碼。

If a TIN is unavailable, provide the appropriate reason A, B or C 如沒有提供稅務編號，必須填寫合適的理由 A, B 或 C:

# Reason A - The jurisdiction where the account holder is a resident for tax purposes does not issue TINs to its residents.

理由 A - 賬戶持有人的居留司法管轄區並沒有向其居民發出稅務編號。

Reason B - The account holder is unable to obtain a TIN. Explain why the account holder is unable to obtain a TIN if you have selected this reason.

理由 B - 賬戶持有人不能取得稅務編號。如選取這一理由，解釋賬戶持有人不能取得稅務編號的原因。

Reason C - TIN is not required. Select this reason only if the authorities of the jurisdiction of residence do not require the TIN to be disclosed.

理由 C - 賬戶持有人毋須提供稅務編號。居留司法管轄區的主管機關不需要賬戶持有人披露稅務編號。

Jurisdiction of

Residence

居留司法管轄區

TIN

稅務編號

#Enter Reason A, B or C if no TIN is

available

如沒有提供稅務編號，填寫理由 A,B

或 C

Explain why the account holder is unable to obtain

a TIN if you have selected Reason B

如選取理由 B，解釋賬戶持有人不能取得稅務編

號的原因

(1)

(2)

(3)

Part 3: Declarations and Signature 第 3 部:聲明及簽署

I acknowledge and agree that (a) the information contained in this form is collected and may be kept by the financial institution for the purpose of automatic exchange of financial account information, and (b) such information and information regarding the account holder and any reportable account(s) may be reported by the financial institution to the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which the account holder may be resident for tax purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112). 本人知悉及同意，財務機構可根據《稅務條例》（第

112 章）有關交換財務帳戶資料的法律條文，（a）收集本表格所載資料並可備存作自動交換財務帳戶資料用途及（b）把該等資料和關於帳戶持有人

及任何須申報帳戶的資料向香港特別行政區政府稅務局申報，從而把資料轉交到帳戶持有人的居留司法管轄區的稅務當局。

I certify that I am the account holder to sign for the account holder of all the account(s) to which this form relates. 本人證明，就與本表格所有相關的帳戶，

本人是帳戶持有人簽署本表格。

I undertake to advise ZJ Securities of any change in circumstances which affects the tax residency status of the individual identified in Part 1 of this form or causes the information contained herein to become incorrect, and to provide ZJ Securities with a suitably updated self-certification form within 30 days of such change in circumstances. 本人承諾，如情況有所改變，以致影響本表格第 1 部所述的個人的稅務居民身分，或引致本表格所載的資料不正確，本人

會通知中佳證券，並會在情況發生改變後 30 日內，向中佳證券提交一份已適當更新的自我證明表格。

I declare that the information given and statements made in this form are, to the best of my knowledge and belief, true, correct and complete. 本人聲明

就本人所知所信，本表格內所填報的所有資料和聲明均屬真實、正確和完備。

Signature 簽署

X Date (dd/mm/yyyy) 日期 (日／月／年):

Name 姓名

WARNING: It is an offence under section 80(2E) of the Inland Revenue Ordinance if any person, in making a self-certification, makes a statement that is misleading, false or incorrect in a material particular AND knows, or is reckless as to whether, the statement is misleading, false or incorrect in a material particular. A person who commits the offence is liable on conviction to a fine at level 3 (i.e. $10,000).警告: 根據《稅務條例》第 80(2E)條，如任何人在

作出自我證明時，在明知一項陳述在要項上屬具誤導性、虛假或不正確，或罔顧一項陳述是否在要項上屬具誤導性、虛假或不正確下，作出該項陳

述，即屬犯罪。一經定罪，可處第 3 級（即$10,000）罰款。


Tel 電話: (852) 2115 8467 Fax 傳真: (852) 2110 4005


Exchange Participant of the Stock Exchange of Hong Kong Limited

香港聯合交易所之參與者

Licensed Corporation of the Securities and Futures Commission

證券及期貨事務監察委員會之持牌法團

CE No. 中央編號: BHO840

「中佳與交通銀行」聯合發出的子賬戶申請表格

客戶名稱:___________________

身份證/護照號碼: ________________

商業登記證號碼/公司註冊證書號碼:__________________

本人/本公司現向貴公司(「中佳證券有限公司」)申請一個「中佳與交通銀行」聯合發出的子賬戶，作

為日後存款用途。

本人/本公司已清楚當款項存入貴公司時，一般存款做法收款人名稱是寫上「中佳證券有限公司」，但

是“子賬戶”是以客戶本人的姓名/本公司的名稱為收款人，所以本人/本公司謹此聲明當本人/本公司

一經選擇透過交通銀行有限公司的“子賬戶”方法存入款項時，即使於存款表格上填寫抬頭或收款人

為本人的姓名/本公司的名稱，亦表明及確認該筆款項是存入本人/本公司在中佳證券有限公司的戶口

內。

客戶簽署：

_______________________________

(請用留存本公司記錄之簽署式樣)

日期：__________________________

中佳內部專用

===========================================================================================

客戶中佳賬戶編號: _______________________________

「中佳與交通銀行」聯合發出的子賬戶編號:_______________

S.V.

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