Lucky draw details
“AXA Health Booster Lucky Draw” Registration form
“AXA Health Booster Lucky Draw”
Registration form
Name
Surname (in English)
*
Please enter surname
Surname must be in English only
Given name (in English)
*
Please enter given name
Given name must be in English only
(Must be matched with your AXA policy record)
Contact information
Email address
*
Please enter email address
Please enter a valid email address
Email address (Re-enter)
*
Please re-enter email address
Email addresses do not match
Area code
*
Please enter area code
Mobile number
*
Please enter mobile number
Hong Kong mobile number must be exactly 8 digits
Hong Kong mobile number must contain only digits
Hong Kong mobile must start with 4,5,6,7,8 or 9
Mobile number must contain only digits
(Please provide a valid email address and mobile number for prize notification purpose.)
Identity document
Hong Kong identity card
Valid travel document
*
Please fill in the alphabet(s) and the first 3 digits of Hong Kong Identity Card number
(Must be matched with your AXA policy record)
Click to select all boxes below
I confirm that I have read, understood and agreed the
Terms and Conditions
of "AXA Health Booster Lucky Draw". I confirm that my participation in the lucky draw has no influence on my decision regarding any insurance product, and that any application for AXA policy I submit is solely based on my insurance needs and my understanding of the product.
*
Optional:
I acknowledge and confirm that I have read and understood the
Privacy Policy
(including
Privacy Policy - Mainland China Appendix
, if applicable) and
Personal Information Collection Statement
(Statement), and I agree with the use and provision of my personal data for direct marketing purposes as set out in the Statement by AXA (see "Use and provision of personal data in direct marketing" ) and agree to receive AXA's promotional and direct marketing materials.
Trade Promotion Competition Licence No.: 61711-4
⚠️ Please accept both required consent items to proceed.
Remarks:
Email address and mobile number provided by customer will be used for this lucky draw's registration and prize notification purposes. The identity document information will only be used to verify the identity of the customer. For more details, please refer to the
Terms and Conditions
and the
Personal Information Collection Statement
for the lucky draw.
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Contact Information
Surname (in English)
Given name (in English)
Email address
Email address (Re-enter)
Mobile number
Identity document
Terms & Conditions
Marketing Opt-in
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