Essential Services Corps.
[CAP. 197
[r. 5.]
FORM IV.
Declaration of member declining Medical Examination.
I,
do not desire to undergo medical examination. I understand that in the event of application by me for disability pension or of application by my wife, child or other dependant for pension or allowance on the grounds that my death is due to injury or illness attributable to or aggravated by my service in the Corps, a Medical Board may report that it is unable to make recommendation because of the absence of information regarding my medical condition prior to enrolment or being called out for actual service.
Signature of Witness.
Date.
Signature of Member.
Date.
FORM V.
Declaration of Member who has not passed the Medical Examination.
[r. 5.] G.N.A. 164/50.
I,
understand that in the event of application by me for disability pension, or of application by my wife, child or other dependant for pension or allowance on the grounds that my death was due to illness attributable to or aggravated by my service in the Corps, a Medical Board may report that it is unable to make recommendation because of my medical condition prior to being called out for actual service.
Signature of Witness.
Signature of Member.
Date.
FORM VI.
Date.
[r. 16.]
Certificate of cancellation of enrolment.
I certify that the enrolment of
as a member of the Essential Services Corps has been cancelled with effect from the ............day of
19......
Date
Commissioner, Essential
Services Corps,
Hong Kong.
19......
423
Page 10
Page 11
Essential Services Corps.
[CAP. 197
[r. 5.]
FORM IV.
Declaration of member declining Medical Examination.
I,
.do not desire to undergo medical examination. I understand that in the event of application by me for disability pension or of application by my wife, child or other dependant for pension or allowance on the grounds that my death is due to injury or illness attributable to or aggravated by my service in the Corps, a Medical Board may report that it is unable to make recommendation because of the absence of informa- tion regarding my medical condition prior to enrolment or being called out for actual service.
Signature of Witness.
Date.
Signature of Member.
Date.
FORM V.
Declaration of Member who has not passed the Medical Examination.
[r. 5.] G.N.A. 164/50.
I,
understand that in the event of application by me for disability pension, or of application by my wife, child or other dependant for pension or allowance on the grounds that my death was due to illness attributable to or aggravated by my service in the Corps, a Medical Board may report that it is unable to make recommendation because of my medical condition prior to being called out for actual service.
Signature of Witness.
Signature of Member.
Date.
FORM VI.
Date.
[r. 16.]
Certificate of cancellation of enrolment.
I certify that the enrolment of
as a member of the Essential Services Corps has been cancelled with effect from the ............day of
19......
Date
Commissioner, Essential
Services Corps,
Hong Kong.
19......
423
Page 10Page 11
No comments yet.
Private notes are available after approval.