Surviving Spouses' and Children's Pensions Scheme 尚存配偶及子女撫恤金計劃
ELECTION FORM A 選擇表格A
Departmental Serial No.
Annex II
A
部門編號
I.. (To be cohened in triplicate by an officer who wishes to join/re-join the Surviving Spouses' and Children's Pensions Scheme)
(本表格由擬參加/再參加尚存配偶及子女也金計劃的公務員以一式三份填寫!
1.
To: Director of Accounting Services
致: 庫務署署長
via
經
(Head of Department)
(部門首長)
I wish to join/re-join the Surviving Spouses' and Children's Pensions Scheme as from 本人疑由
being
起。
2
(Day)
(日)
(Moath) (Year)
(A) (#)
參加/再參加尚存配偶及子女撫懷金計劃。上述日期為
a. the date of my "first appointment/re-appointment/transfer to the Hong Kong Government or of my transfer from agreement terms
to the permanent establishment
本人 *首次受聘/再行受聘/轉職政府或由合約條件人員轉為常額編制人員的日期。
b. the date of my *marriage/re-marriage
本人 *結婚/再進日期..
c. the date last ceased to contribute to the *Widows and Orphans Pension Scheme/Widows' and Children's Pensions Scheme
本人最後停止供款于“孤事撫恤金計劃/遠端及子女進恤金計劃的日期。
d. the date of commencement of the Surviving Spouses' and Children's Pensions Scheme
尚存配偶及子女撫恤金計劃開始生效日期。
e. the date on which I was holding an office of artisan or senior artisan (applicable if the date is 1.10.89 only)
本人正任職技工或高级技工的日期。(適用於若上述日期為一九八九年十月一日 )
•
If there are any arrears of contributions arising from this election, I wish to repay them plus interest, if appropriate, to the Government by 如因是項選擇而引致任何欠繳供款,本人齪採用下列方法,將欠款連同利息(如適合者)一併歸還政府:
a. one lump sum
一筆過還款。
b. monthly instalment of $
分期付款,每月由薪金内扣除不少於薪金之5% 的款項共
being not less than S% of my salary, through payroll
元。
c. a dowapayment of | $
and the balance by moathly instalment of S
5% of my salary. through payroll 首期付款
being not less than
元,餘款分期繳付,每月由薪金內扣除不少於薪金之5%的款額共
一元.
3.
I understand and accept that the election made in the first paragraph is irrevocable. 本人明白並同意在第一段所作的選擇是不能更改的。
Signature
簽署
Name (in BLOCK Letters)
姓名(請用正楷填寫)
Hong Kong I.C. No.
香港身份證號碼
Rank
職級
II. (To be completed by Head of Department)
(由部門首長填寫)
To: Director of Accounting Services
致:運務署署長
TRN
庫務署樓號
Date
日期
(Day)
(Month)
(日)
(月)
(Year) (年)
*I confirm that the applicant is eligible to join the Surviving Spouses' and Children's Pensions Scheme under the terms set out in CSB Circular No. *本人建實申請人符合公務員事務科通告第
/92 號所列的條件,其資格參加尚存配偶及子女撫恤金計劃。
*The officer's application to join the Surviving Spouses® and Children's Pensions Scheme has been rejected vide SCS's memo Ref.
dated.
The officer has been informed of the rejection and the reasons thereof. *有關人員參加尚存配偶及子女撫恤金計劃的申請不獲批准(參看_
年 月
日公務員事務司忘錄檔號
,該人員已獲告知申請不獲批准及不獲批准的原因
• Delete if inappropriace 請將不適用當去
➡ Tick as appropriate
請在理港方能内加上/號
Distribution
Original
to be forwarded to the Treasury to be retained by the Department
Duplicate Triplicate to be returned to the applican:
G.F. 564A
分發名單
正
本- 送交南務署
第一期期一由有關部門保存 第二副本 - 交回申請人
for
(Head of Department) 部門首長(
代行)
Date:
日期:
See Notes
Overleni 見後真註人
1&2
3 & 4
192.