TNAG-2667-FCO40-3864-Hong-Kong-Civil-Service-1993 — Page 205

Surviving Spouses' and Children's Pensions Scheme

附件II

Departmental Serial No.

部門編號

A

尚存配偶及子女撫恤金計劃

選擇表格A

ELECTION FORM A

L (To be completed 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撫恤金計劃的公務員以一式三份填寫!

To: Director of Accounting Services

致: 庫務署署長

via

經

(Head of Department)

(部門首長)

1.

I wish to join/re-join the Surviving Spouses' and Children's Pensions Scheme as from 本人疑由

being

起

2.

(Day) (Month) (Year)

(日) (A) (年)

參加/再參加尚存配偶及子女迤壇金計劃。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,再婚日期

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寡撫懷金計劃/遺孀及子女金計劃的日期。

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 1.10.39 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,本人擬採用下列方法,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 S

分期付款,每月由薪金內扣除不少於薪金之5%的款項共

being not less than 5% of my salary, through payroll

元。

c. a downpayment of | $

5% of my salary, through payroll 首期付款

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

and the balance by monthly instalment of 5

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。

.元·

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

[l. (To be completed by Head of Department)

(由部門首長填寫)

To: Director of Accounting Services

致: 庫務署署長

TRN

庫務署檔號

Date

日期

(Day)

(Month)

(Year)

(日)

(月)

(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. *本人證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懷金計劃的申請不獲批准(參署. 一該人員已獲告知申請不獲批准及不獲批准的原因

月

日公務員事務司縮忘錄檔號

* Delete if inappropriace 請將不適用當緊去

= Tick as appropriate

請在蕉港方能去加上/號

Distribution

Original Duplicate Triplicate

G.F. 364.A

-

to be forwarded to the Treasury to be retained by the Department to be returned to the applicant

分發名單

正 本送交凰務署

由有關部門保存 第一副本 第二副本 - 交回申請人

(

for

(Head of Department) 部門首長(

代行)

Date:

日期:

See Notes

Overleaf 見後真註釋

1 & 2

3 & 4

192.