TNAG-2667-FCO40-3864-Hong-Kong-Civil-Service-1993 — Page 185

I.

Annex III

Widows and Orphans Pension Scheme/Surviving Spouses' and Children's Pensions Scheme

ELECTION FORM B

(To be completed in triplicate by a married contributor who wishes to discontinue contributing to WOPS/SSCPS)

To: Director of Accounting Services

via

(Head of Department)

I hereby elect to discontinue contributing to the *Widows and Orphans Pension Scheme/Surviving Spouses' and Children's Pensions Scheme with effect from

1.2.1993

4/93

(the implementation date) and to retain the pension benefits

in accordance with the terms of Civil Service Branch Circular No. which I have acquired at that date.

I understand and accept that this election is irrevocable.

Signature of

Witness

Name in

BLOCK LETTERS

Hong Kong I.C. No.

Date

Signature

Name in

BLOCK LETTERS

Hong Kong I.C. No.

TRN

Date

B

(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

Triplicate

to be forwarded to the Treasury Duplicate to be retained by the Department

to be returned to the applicant

G.F. 564B

for (

(Head of Department)

Date

>