DBS ALTITUDE CARD

PRIORITY PASS MEMBERSHIP APPLICATION

Completed form may be sent in via the enclosed Business Reply Envelope.

HKTCDBSVASP12

Yes, I would like to receive the complimentary Priority Pass membership.

Title

First Name

Surname

_______________

_____________________________________

___________________________________________________

Company Name
____________________________________________________________________________________________________________
Address Line 1
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Address Line 2
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Country

Postal Code

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Email Address
____________________________________________________________________________________________________________
Tel No

Fax No

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Your Name (as shown on DBS Altitude Visa Signature Card)
____________________________________________________________________________________________________________
Card Billing Address (if different from above)
____________________________________________________________________________________________________________
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DBS Altitude Visa Signature Card No. 4 1 1 9

Expiry Date (MM/YY)

I understand that the Priority Pass membership (Membership) is only applicable to Principal DBS Altitude Visa Signature Card Cardholder.
I understand that the Membership is free for the rst 5 years and is subject to further renewals, in DBS and Priority Pass Ltds discretion.
I understand that the Membership will be terminated in the event my DBS Altitude Visa Signature Card account (Card Account) is terminated and that I am liable for
all authorised card transactions charged to the Card Account, including but not limited to Priority Pass lounge visits. I acknowledge that if my Card Account is reinstated
or if I apply for a new Card Account, I will have to submit a fresh Membership application.
I understand that I am entitled to 2 complimentary lounge visits for each 12-month Membership tenure and these complimentary visits are not applicable to guests. I
hereby instruct Priority Pass Ltd to charge to my DBS Altitude Visa Signature Card lounge fees at the prevailing rate of USD27 per person for (1) my visits in excess of 2
complimentary visits during each 12-month Membership tenure; and (2) my guests for each visit. I understand that applicable charges will be based on the date of my
visits. All complimentary visits must be used by the expiry date on the Priority Pass membership card. Unused complimentary visits cannot be carried over to the next
12-month Membership tenure.
I would like DBS to forward my personal particulars herein to Priority Pass Ltd to process this application. I further acknowledge that Priority Pass Ltds sole use of data relating
to me shall be in respect of the delivery of the Priority Pass benet(s).
Renewal terms and conditions are at the discretion of Priority Pass Ltd. I agree to abide by the Conditions Of Use as contained in Priority Pass Ltds lounge directory.

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Your Signature

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Date

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06-07-189
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