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HKID Card or Passport No. :	HKID Card No. :     ( ) Passport No. :
Date of Birth:
Card Type:	----------------- Pacific Visa Gold Pacific Visa Classic Go-Goal Visa Gold Go-Goal Pearl Visa Classic Go-Goal Green Visa Classic Visa Platinum Go-Goal Visa Platinum Internet Pacific Card FWD CUP Gold FWD CUP Diamond FWD Visa Classic FWD Visa Platinum MI Credit Card China UnionPay Dual Currency Gold China UnionPay Dual Currency Diamond Yan Chai China UnionPay Dual Currency Gold Card Yan Chai Hospital Board China UnionPay Dual Currency Diamond Card Yan Chai China UnionPay Dual Currency Diamond Card
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