TNAG-2667-FCO40-3864-Hong-Kong-Civil-Service-1993 — Page 113

A

Annex B

Section A

(for completion by officer)

Nomination of Spouse

for Death Gratuity and Ex-gratia Payment

Distribution:

Original--Treasury

Duplicate Head of Department

Triplicate Officer

Nomination

To: Secretary for the Civil Service via

(Head of Department)

I,

(name of officer) hereby nominate my *husband/wife

(full name in BLOCK letters) holder of HK Identity Card

No.

of (address).

to receive the death gratuity or ex-gratia payment which may be payable under the Pensions Ordinance (Cap. 89), Pension Benefits Ordinance (Cap. 99) or the Pension Benefits (Judicial Officers) Ordinance (Cap. 401). For easy reference, I enclose the documentary evidence of my relationship with the nominee.

I understand that-

(a) a nomination shall not be valid at the time of my death if the nominee was my husband or wife at the time of this

nomination, but the marriage has come to an end; or if the nominee has died,

(b) the nomination may be revoked at any time by a subsequent, notice in writing to the Secretary for the Civil Service in the

prescribed form, and

(c) I shall notify the Secretary for the Civil Service via Director of Accounting Services and revoke the nomination when my

wife/husband died or when my marriage came to an end.

Name:

Rank:

Address:

Witnessed by:

Name:

HK Identity

Card No.:

(BLOCK Letters)

Signature:

HK Identity Card No.:

TRN:

Date:

Signature:

(BLOCK Letters)

Date:

* Delete where inapplicable

Section B

(for completion by department)

To: Secretary for the Civil Service via

Director of Accounting Services,

The personal particulars in Section A have been verified and found correct. According to my records, the nominee is the *husband/wife of the officer as at the time of the nomination.

A copy of this form has been returned to the officer for his retention.

Rank:

Signature:

(for

}

(Head of Department)

Date:

* Delete where inapplicable

Notes

Name:

1.

2.

3.

A copy of this form will be returned to the officer for his/her retention. If it is not received within 1 month, the officer should contact his/her department immediately. for clarification.

The officer should ensure that both the Treasury and his/her department are advised of any change in his/her nominee's address, if it is different from the officer's normal correspondence address kept by his/her department. A lack of up-to-date information may cause delay in payment of death benefit.

In any case where there is no valid nomination, the death gratuity or ex-gratia payment will be paid to the officer's legal personal representative.

4.

It is the nominator's responsibility to ensure that the nominee is acquainted with the terms of this nomination.

G.F. 594