GRADUATE SCHOOL
Transcript/Testimonial Fee - Credit Card Payment Form

Student Information:

Name:	___________	___________________________	Student No.:	_____________
	(Surname)	(Other Name)

Correspondence Address:	______________________________________________________

________________________________________________________________________

Telephone No.:	_______________________	Fax No.:	________________________

Email Address:	_______________________

Type of Credit Card (Please )

	□	Visa Card	□		Master Card

Credit Card No.:	_________________________________________________	

CVV (Visa) / CVC (Master) Code:	_________________________________________________
	(The LAST 3 digits of numbers printed on the signature field at 
 the back of the credit card)

Card Holder Name:	_________________________________________________

Expiry Date:	_________________________________________________

Transcript/Testimonial/Postage Fee:	HK$		
	(Please do not change the payment to other currency.)  

Signature:	_________________________________________________
	(Please use authorized signature as shown on your credit card.)

Date:	_________________________________________________

Please submit this form to the Graduate School either by mail or by fax.

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Personal Data (Privacy) Ordinance :  Personal Information Collection Statement

Persons who supply personal data in their applications to the Graduate School for various purposes are requested to note the following:

1.	Personal data provided in the applications are to facilitate the process of their applications and will not be used for other purposes.
2.	Personal data provided will only be used by University staff.
3.	After the applications have been processed, application forms will be destroyed 3 months after the process is over.

Under the provision of the Personal Data (Privacy) Ordinance, request for personal data access or correction may be made and addressed to the Graduate School. 
Contact details: 
			Graduate School
			AAB 904, Level 9, Academic and Administration Building,
			Baptist University Road Campus,
			Hong Kong Baptist University
			Kowloon Tong
			Kowloon
										Fax: 	(852) 3411-5133	
										Phone: 	(852) 3411-5127