1964_ESSENTIAL_SERVICES_CORPS_(GENERAL)_REGULATIONS — Page 10

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CAP. 197]

Essential Services Corps (General) Regulations

[1974 Ed.

[Subsidiary]

G.N.A. 4/61.

G.N.A. 92/53.

SECOND SCHEDULE

FORM I

Declaration

[r. 4.]

I,

do hereby declare that I will serve with the Essential Services Corps in accordance with the provisions of the Essential Services Corps Ordinance, Chapter 197, and regulations made thereunder.

FORM II

Signature of Member.

Date.

I certify that

Certificate of Enrolment

has this day been enrolled as a member of the Essential Services Corps,

Commissioner, Essential

Services Corps, Hong Kong.

Date

19......

[r. 4.]

G.N.A. 4/61.

L.N. 49/67.

FORM III

Declaration of member declining Medical Examination

[r. 5.]

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 any 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 active service.

Signature of Witness.

Date.

Signature of Member.

Date.

Page 10

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CAP. 197] Essential Services Corps (General) Regulations [1974 Ed. [Subsidiary] G.N.A. 4/61. G.N.A. 92/53. SECOND SCHEDULE FORM I Declaration [r. 4.] I, do hereby declare that I will serve with the Essential Services Corps in accordance with the provisions of the Essential Services Corps Ordinance, Chapter 197, and regulations made thereunder. FORM II Signature of Member. Date. I certify that Certificate of Enrolment has this day been enrolled as a member of the Essential Services Corps, Commissioner, Essential Services Corps, Hong Kong. Date 19...... [r. 4.] G.N.A. 4/61. L.N. 49/67. FORM III Declaration of member declining Medical Examination [r. 5.] 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 any 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 active service. Signature of Witness. Date. Signature of Member. Date. Page 10
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A 10 CAP. 197] Essential Services Corps (General) Regulations [1974 Ed. [Subsidiary] G.N.A. 4/61. G.N.A. 92/53. SECOND SCHEDULE FORM I Declaration [r. 4.] I, do hereby declare that I will serve with the Essential Services Corps in accordance with the provisions of the Essential Services Corps Ordinance, Chapter 197, and regula- tions made thereunder. FORM II Signature of Member. Date. I certify that Certificate of Enrolment has this day been enrolled as a member of the Essential Services Corps, Commissioner, Essential Services Corps, Hong Kong. Date 19...... [r. 4.] G.N.A. 4/61. L.N. 49/67. FORM III Declaration of member declining Medical Examination [r. 5.] 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 any 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 active service. Signature of Witness. Date. Signature of Member. Date. Page 10!
2026-05-04 16:34:23 · Baseline
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A 10

CAP. 197]

Essential Services Corps (General) Regulations

[1974 Ed.

[Subsidiary]

G.N.A. 4/61.

G.N.A. 92/53.

SECOND SCHEDULE

FORM I

Declaration

[r. 4.]

I,

do hereby declare that I will serve with the Essential Services Corps in accordance with the provisions of the Essential Services Corps Ordinance, Chapter 197, and regula- tions made thereunder.

FORM II

Signature of Member.

Date.

I certify that

Certificate of Enrolment

has this day been enrolled as a member of the Essential Services Corps,

Commissioner, Essential

Services Corps, Hong Kong.

Date

19......

[r. 4.]

G.N.A. 4/61.

L.N. 49/67.

FORM III

Declaration of member declining Medical Examination

[r. 5.]

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 any 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 active service.

Signature of Witness.

Date.

Signature of Member.

Date.

Page 10!

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