DBS Altitude Visa Signature Card No. 4 1 1 9 - 1 1 0 0 - -
Expiry Date (MM/YY)
Completed form may be sent in via the enclosed Business Reply
Envelope.
Yes, I would like to receive the complimentary Priority Pass
membership.
Title First Name Surname
_______________ _____________________________________
___________________________________________________
Company Name
____________________________________________________________________________________________________________
Address Line 1
____________________________________________________________________________________________________________
Address Line 2
____________________________________________________________________________________________________________
Country Postal Code
____________________________________________________________________________________________________________
Email Address
____________________________________________________________________________________________________________
Tel No Fax No
____________________________________________________________________________________________________________
Your Name (as shown on DBS Altitude Visa Signature Card)
____________________________________________________________________________________________________________
Card Billing Address (if different from above)
____________________________________________________________________________________________________________
DBS ALTITUDE CARDPRIORITY PASS MEMBERSHIP APPLICATION
HKTCDBSVASP12
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I understand that the Priority Pass membership (Membership) is
only applicable to Principal DBS Altitude Visa Signature Card
Cardholder.
I understand that the Membership is free for the rst 5 years and
is subject to further renewals, in DBS and Priority Pass Ltds
discretion.
I understand that the Membership will be terminated in the event
my DBS Altitude Visa Signature Card account (Card Account) is
terminated and that I am liable for all authorised card
transactions charged to the Card Account, including but not limited
to Priority Pass lounge visits. I acknowledge that if my Card
Account is reinstated or if I apply for a new Card Account, I will
have to submit a fresh Membership application.
I understand that I am entitled to 2 complimentary lounge visits
for each 12-month Membership tenure and these complimentary visits
are not applicable to guests. I hereby instruct Priority Pass Ltd
to charge to my DBS Altitude Visa Signature Card lounge fees at the
prevailing rate of USD27 per person for (1) my visits in excess of
2 complimentary visits during each 12-month Membership tenure; and
(2) my guests for each visit. I understand that applicable charges
will be based on the date of my visits. All complimentary visits
must be used by the expiry date on the Priority Pass membership
card. Unused complimentary visits cannot be carried over to the
next 12-month Membership tenure.
I would like DBS to forward my personal particulars herein to
Priority Pass Ltd to process this application. I further
acknowledge that Priority Pass Ltds sole use of data relating to me
shall be in respect of the delivery of the Priority Pass bene
t(s).
Renewal terms and conditions are at the discretion of Priority
Pass Ltd. I agree to abide by the Conditions Of Use as contained in
Priority Pass Ltds lounge directory.
__________________________________
__________________________________Your Signature Date
Priority Pass App Form.indd 1 5/8/13 5:22 PM
