I.
Annex IV
Widows and Orphans Pension Scheme/Surviving Spouses' and Children's Pensions Scheme
ELECTION FORM C
(To be completed in triplicate by a single/widowed/divorced contributor, or a female contributor, who wishes to discontinue contributing to WOPS/SSCPS)
To: Director of Accounting Services
via
(Head of Department)
I declare that as at
1.2.1993
(the date of implementation) I remained a
*bachelor/widow/widower/divorcee/with pensionable child(ren)/without pensionable child(ren).
I hereby elect to discontinue contributing to the Widows and Orphans Pension Scheme/Surviving Spouses' and Children's Pensions Scheme and to receive a refund of my contributions, if any, in accordance with the terms of Civil Service Branch Circular No. 4/93.
I understand and accept that this election is irrevocable.
Signature of
Witness
Name in
BLOCK LETTERS
Hong Kong L.C. No.
Date
Signature
Name in
BLOCK LETTERS
Hong Kong I.C. No.
TRN
Date
C
(Day)
(Month)
(Year)
II. To: Director of Accounting Services
I have returned the triplicate copy of this form to the officer for his retention.
* Delete as appropriate
Distribution
Original
to be forwarded to the Treasury
Triplicate G.F. 564C
Duplicate to be retained by the Department
to be returned to the applicant
(
for (
Date
(Head of Department)
)