Claim Form For Payment Of Accrued Benefits 累算权益申索表格
Notes : (1) This Form should be completed by any person who is eligible to claim for payment of MPF accrued benefits. (2) If claimant/scheme member has more than one account in a registered scheme, the claimant should fill in one form for payment of accrued benefits in respect of all accounts within one scheme. If a claimant/scheme member has accounts with more than one service provider, the claimant should fill in one form for each service provider. (3) Please use BLOCK LETTERS for completion of this Form. (4) Please initial next to any corrections you make on this form. (5) *Means delete whichever is inappropriate. (6) The completed form should be sent to the scheme administrator, "Provident Funds Services, Manulife (International) Limited, at 21/F., Tower A, Manulife Financial Centre, 223-231 Wai Yip Street, Kwun Tong, Kowloon, Hong Kong". (7) The information and data given in this Form can be used by the approved trustee concerned and the Mandatory Provident Fund Schemes Authority in activities relating to the processing of the claim and may be disclosed to other parties for such purposes. You have the right of access and correction in respect of your information in the possession of Manulife. 注意事项: (1) 本表格需由合资格申索强积金累算权益的人士填写. (2) 倘索偿人/计划成员在注册计划内拥有超过一个帐户,索偿人应就申索一 个计划内所有帐户的累算权益填写一份表格.倘索偿人/计划成员在多过 一个服务供应商内拥有帐户,索偿人应就每个服务供应商填写一份表格. (3) 请以正楷填写本表格. (4) 如须作出任何更改,请於删改之位置旁签署. (5) *表示把不适当之处删除. (6) 填妥的表格寄交计划管理人「香港九龙观塘伟业街223-231号宏利金融中 心A座21楼宏利人寿保险(国际)有限公司公积金服务部」. (7) 有关的认可受托人及强制性公积金管理局可利用本表格提供的资料处理与 索偿有关事宜,并可为该等目的而把所填写的资料向其他方面披露.阁下 有权取得并更改於宏利持有与阁下有关的资料.
Section I – Details of The Scheme Member / Claimant 第一部份 – 计划成员 / 索偿人资料
(1) Scheme Member 计划成员 (i) Name : (as shown on ID Card) 姓名(必须与身份证相同 ) Surname in English 英文姓氏 Other Name in English 英文名字 Name in Chinese 中文姓名 HKID Card / Passport Number Note1 : (iii) Date of Birth: 香港身份证 / 护照*号码 注1 ( ) 出生日期 Daytime Contact Number : dd日 / mm月 / yyyy 年 日间联络电话号码 Name of the Scheme : 计划名称 I would like to withdraw the accrued benefits under all my member account(s)^. 本人欲从本人的所有成员帐户^内提取累算权益. Yes 是 No, my Member Account Number(s) Note 2 is/are 否,本人之成员帐户号码为 (1) (2) If no option is chosen, it will be deemed that the request for withdrawal of accrued benefits applies to all your member account(s)^. 如没有选项,将视作阁下指示宏利从阁下的所有成员帐户^内提取累算权益.

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