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DRAGON 100 (龍匯100) 2015: Online Application Form
Information provided shall only be used for the purpose of application processing and programme promotion. Data of unsuccessful applicants shall be destroyed.
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* Indicates required question
(A) Personal Particulars
Surname
*
Your answer
First Name
*
Your answer
姓氏(in Chinese)
Your answer
名字(in Chinese)
Your answer
Date of birth (dd/mm/yyyy)
*
Your answer
Age
*
Your answer
Place of Birth
*
Your answer
Gender
*
Your answer
Nationality
*
Your answer
Country / Region of nominating organization
*
Your answer
Years of Residence in Country of nominating organization
*
Your answer
Chinese Ethnicity
*
Paternal
Maternal
Both
None
(B) Language(s)
English
*
Excellent
Fluent
Basic
Incomprehension
Putonghua
*
Excellent
Fluent
Basic
Incomprehension
(1)Other Language
Your answer
(1)Other Language Level
Choose
Excellent
Fluent
Basic
Incomprehension
N/A
(2)Other Language
Your answer
(2)Other Language Level
Choose
Excellent
Fluent
Basic
Incomprehension
N/A
(C) Travelling Document
1.Nominees should apply for their own Visa.
2.Nominees should send their passport copy & passport photo(in JPEG or TIF format )to The Dragon Foundation.
Type
*
Your answer
Expiry Date(dd/mm/yyyy)
*
Your answer
Document No
*
Your answer
Issuing Authority
*
Your answer
Need to apply Visa to
*
Hong Kong
Mainland China
N/A
Required
(D) Correspondence
Correspondence Address
*
Your answer
Tel. No (Residence)
(country code) area code - no.
Your answer
Tel. No (Mobile)
*
(country code) area code - no.
Your answer
Fax No.
(country code) area code - no.
Your answer
Email Address 1
*
Your answer
Email Address 2
Your answer
Residential Address
If different from correspondence address
Your answer
(E) Emergency Contact
Name of Contact Person
*
Your answer
Relationship
*
Your answer
Address
*
Your answer
Tel. No (Day)
*
(country code) area code - no.
Your answer
Tel. No (Evening)
*
(country code) area code - no.
Your answer
E-mail Address
Your answer
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