Form Ver.2

2006/05

₳ὢ㞫▉/∔⒠㞫▉嵯㙁㞜㙘夐㣤 Individual / Corporate Member’s Information Update Form 㞫噱椆⋍ Membership Type 㞫▉亐圇 Membership no. ₳ὢổ㘯⩻⒵㊾∔⒠ổ㘯∐⒵ Individual Name or Company *⇰䗇/⧒⧒/ⲷ⩸/⨛ώ/ * ₳ὢ / ∔⒠ Name in Chinese ␂⦓ * Individual / Corporate *Mr./Mrs./Miss/Ms./Dr. O S H / / ₳ὢ厙㘯⩻⒵㊾∔⒠厙㘯∐⒵ Individual Name or Company Name in English

㞜㗡₳ὢ㞫▉ῷⰭ⟘⟨ CHANGE OF PERSONAL HOME ADDRESS 厙㘯ῷⰭ⟘⟨ Home Address in English

ῷⰭ枣嬙 Home Telephone

㋳㑸枣嬙 Mobile

⅛┤㬇 Pager

ῷⰭ⅛䟇 Home Fax

₳ὢ枣憝₉䱙 Personal E-mail Address

㞜㗡∔⒠嵯㙁!CHANGE OF COMPANY DETAILS ổ㘯 * ↙ợ / ䷬償 / ∔⒠⒵䫙 Name of * Employer / Company / Organisation in Chinese 厙㘯 * ↙ợ / ䷬償 / ∔⒠⒵䫙 Name of * Employer / Company / Organisation in English 㙘ᾣ┥∔⒠㊾䷬仼儗三ὢ⩻⒵ New Assigned Company or Organisation Coordinator * ₳ὢ⑿↙償῵ / ䷬仼㊾∔⒠儗三ὢ償῵ * Position of Employment / Position of Company / Organisation Coordinator 厙㘯∔⒠⟘⟨ Company Address in English

恎ἳ国枣嬙 Business Telephone

恎ἳ国⅛䟇 Business Fax

∔⒠◮㨕䜣嫀亐圇 Business Registration no.

乚梩⟘⟨ Website * ∔⒠ / ䷬償枣憝₉䱙 * Company / Organisation E-mail Address

惂媲⟘⟨ CORRESPONDENCE: * ῷⰭ⟘⟨ Home Address / ∔⒠⟘⟨ Company Address /∞Ⱛ Other ⨪ⴔ∞Ⱛǀ孳嬛䷘⊿⊢ If other, please provide details

㞱Ⓨ㞜㗡∔⒠㊾䷬仼づ圇㊾㫁嬴? Any Change of Company / Organisation logo? *㞱 / 㴺㞱 * Yes / No ⨪㞱ǀ孳㑸⁃殀嶒㬼㣰 If yes, please provide high quality graphic file

嫣ǎ∔⒠㞫▉ね械㑸⁃㞱暄㞜㗡∔⒠嵯㙁寱㚶㘯ᾞ⑲㙤䳥⒵Ẳ啳Ẳ∔⒠␘擹 Remark: For Corporate Member, please provide required document for changing company details and chop for identification.

Effective Date 䗇㗰㚍㟇 ______________ Signature 䳥⒵ __________________ ␘擹 Chop __________ Mail or fax your application to 孳ⲯ䗛孳夐ⱬ➆㊾⅛䟇力ǎ The Secretary of IPSA(HK)Ltd. GPO Box 1852, Central, Hong Kong. 橁㻗ổ䕘ổ⧖憝䱙 1852 圇

➳权Ⲱ㨕₅ⰱ⏼㞫(橁㻗)㞱書∔⒠

⅛䟇 Fax: 2591 4309 * Delete where inapplicable 孳⋒④ẵ愑䗐

䪀㞠㗞