Your account information (* Mandatory ) * Title:   Please select Mr Ms Mrs Miss Dr * Name:   * HSBC Customer Number:    -  - xxx   (If you don't remember your customer number, please call us on 800-820-8878 for help or fill in the first 9 figures of your account number instead. To safeguard your account, please do not fill in the complete account number.) * Telephone:   * Email:   Relationship Manager:   Referee's contact information 1st Referee's contact information: * Title:   Please select Mr Ms Mrs Miss Dr * Name:   * Telephone:   * City:   Please select Beijing Changsha Chengdu Chongqing Dalian Dongguan Foshan Guangzhou Hangzhou Hefei Jinan Ningbo Qingdao Shanghai Shenyang Shenzhen Suzhou Taiyuan Tianjin Wuhan Xiamen Xi'an Zhengzhou Other:   2nd Referee's contact information: Title:   Please select Mr Ms Mrs Miss Dr Name:   Telephone:   City:   Please select Beijing Changsha Chengdu Chongqing Dalian Dongguan Foshan Guangzhou Hangzhou Hefei Jinan Ningbo Qingdao Shanghai Shenyang Shenzhen Suzhou Taiyuan Tianjin Wuhan Xiamen Xi'an Zhengzhou Other:   3rd Referee's contact information: Title:   Please select Mr Ms Mrs Miss Dr Name:   Telephone:   City:   Please select Beijing Changsha Chendu Chongqing Dalian Dongguan Guangzhou Fosan Hangzhou Hefei Jinan Qingdao Ningbo Shanghai Shenyang Shenzhen Suzhou Taiyuan Tianjin Wuhan Xiamen Xi'an Zhengzhou Other:   4th Referee's contact information: Title:   Please select Mr Ms Mrs Miss Dr Name:   Telephone:   City:   Please select Beijing Changsha Chendu Chongqing Dalian Dongguan Foshan Guangzhou Hangzhou Hefei Jinan Ningbo Qingdao Shanghai Shenyang Shenzhen Suzhou Taiyuan Tianjin Wuhan Xiamen Xi'an Zhengzhou Other:   Please confirm that the referees agree to give out all their personal information to HSBC China. The information on your referral form will be used only for HSBC China purposes internally, such as promotion of businesses, services or products. *   I have read and understand the terms and conditions of this program and confirm that I have obtained all necessary authorization from the Referee(s) of my Referrals.