TNAG-0788-FCO40-992-Development-of-social-policy-in-Hong-Kong-proposed-contribut-1978 — Page 82

Claim form

Make your claim by filling in this form. Then send it to your social security office. They will get in touch with you about it. If you are unemployed do not use this form. Instead go to the Unemployment Benefit Office and get form BI.

If you are a couple living together the man should claim.

Surname (Mr/Mrs/Miss).

Other Names.

Address.

I claim supplementary benefit:

Signature

Postcode.

Date.

Are you over pension age (60 for women, 65 for men) Yes__ No_____

If you are a pensioner and would like to talk about your claim at our office instead of having a home visit put an X in this box

Tear this form off and post it to your social security office. You can get the address or a free stamped addressed envelope from your local post office.

If you need money very urgently call at or telephone the

social security office.

This leaflet gives general guidance only and should not be treated as a füll and authoritative statement of the law.

Issued by the Department of Health and Social Security.

2

For Official Use