Credit Card Authorisation Form

Payable only to the BRITISH CONSULATE-GENERAL HONG KONG.

Please charge the following account for the applicable passport and courier fees:

(Note: you may need to notify your bank/credit card company in advance to approve this payment).

Credit card type: X Mastercard X VISA

Card number:

Expiry date: M M / Y Y

Cardholders name:

Passport type and quantity Adult 32-page passport

required: Adult 48-page passport

Child (under 16) 32-page passport

Name(s) of passport 1. 3.

holder: 2. 4.

Delivery Address Details (in English):

Line 1:

Line 2:

Line 3:

City:

State/Province:

Postcode:

Country:

Contact Telephone (Mobile):

-
Contact Telephone (Home):
-

Contact Email Address:

Please Note:

A charge for the return of your new passport(s) and supporting documents will be added to the passport fee. Please visit the passport

pages on our website: www.ukinhongkong.fco.gov.uk for the latest information on fees and delivery charges. Actual fees at the time of

issuance may fluctuate due to exchange rate movements. We will calculate the correct fee on your behalf. Your signature on this form

indicates acceptance of these terms and authorises us to charge the actual fee to your card.

If you require a receipt to be sent to you, please tick here (Note: you will be charged the full courier fee for this service):

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Cardholder signature: Date: