BUILDING & TOILET ACCESS CARD REPLACEMENT APPLICATION FORM BUILDING & TOILET ACCESS CARD REPLACEMENT APPLICATION FORM [ CP-MK-FM011 (Rev.4) ] "*" indicates required fields CENTRAL PLAZABUILDING & TOILET ACCESS CARD REPLACEMENT APPLICATION FORMTo : Central Plaza Management Co. Ltd. [ Suite 2802, Central Plaza / fax no.: 2136 8999 ] From:Name of Tenant* First Last Suite No. / Floor* Contact Person* First Last Tel. No.*RE : LOST / VOID CARDWe hereby request for the replacement of a**lost / void building access control card(s) *with / without the combination of the toilet access function to the card :* lost / void toilet access card(s) according to the following :lost / void building access control card(s)*lostvoid*with / without the combination of the toilet access function to the card*withwithoutName* First Last HKID Card No*Please provide the first 4 digits including the letter, e.g. K123XXX(X). Card No.*Please provide the building & toilet access control card no. Toilet Access Function* Female Toilet Executive Female Toilet Male Toilet Executive Male Toilet Name First Last HKID Card NoPlease provide the first 4 digits including the letter, e.g. K123XXX(X). Card No.Please provide the building & toilet access control card no. Toilet Access Function Female Toilet Executive Female Toilet Male Toilet Executive Male Toilet Name First Last HKID Card NoPlease provide the first 4 digits including the letter, e.g. K123XXX(X). Card No.Please provide the building & toilet access control card no. Toilet Access Function Female Toilet Executive Female Toilet Male Toilet Executive Male Toilet pc(s) – Female Toilet CardCard No.Please provide the building & toilet access control card no. pc(s) – Male Toilet CardCard No.Please provide the building & toilet access control card no. pc(s) – Executive Female Toilet CardCard No.Please provide the building & toilet access control card no. pc(s) – Executive Male Toilet CardCard No.Please provide the building & toilet access control card no. Please tick the appropriate box.* Please issue new card(s) to us. Please issue an invoice for settlement. Select AllWe understand and agree to pay HK$200.00 per building access control card and / or HK$50.00 per toilet access card as the replacement fee (lost or damaged card only).Authorised Signature*Company Chop*Accepted file types: jpg, jpeg, png, gif.Name* First Last Position* Date* DD slash MM slash YYYY Name* First Last Company Chop*Accepted file types: jpg, jpeg, png, gif.PhoneThis field is for validation purposes and should be left unchanged.
