成员离职通知书
Notification of Member Termination
成員離職通知書
Please submit the completed form with original signatory, fax copy will not be processed.請呈交附有親筆簽署之表格,傳真本將不獲處理。
* Please delete the inappropriate item(s).請刪除不適用者 。1.Employer Plan No. 僱主計劃編號:
2. Employer Name 僱主名稱:
3. Particulars of the terminated member (“the Member”) 離職成員(下稱 é成員û )資料:
a)Member Name in English (same as HKID Card/Passport)
成員姓名(與香港身份證/護照上之英文名字相同): b)HKID card/Passport No.* 香港身份證/護照號碼*:
c)Member Account No. 成員賬戶編號:
d)Last day of employment 最後在職日期: (ccyy/mm/dd 年/月/日)
4. Is reimbursement for Long Service Payment (LSP) / Severance Payment (SP) required*? 需要退還長期服務金/遣散費*?
(Note: If no option is being selected, it will be deemed that no reimbursement to the employer is required.)
(註: 如沒有作出任何選擇,成員將視為不會享有長期服務金/遣散費*及無需退還僱主。)qYes (please complete the following) 是 (請填妥以下資料)qNo(please proceed to item 5) 否 (請填寫第五項)
being the Long Service Payment (LSP) / Severance Payment (SP)*. The vested portion of his accrued benefits attributable to the employer’scontributions (“Vested Benefits”) will be reduced by such amount or the amount of Vested Benefits whichever is the lesser. The employer requeststhe Trustee to reimburse the employer for the amount of HK$ ________________.
港幣 元正之長期服務金/遣散費*已於 (年/月/日)由僱主付予僱員/去世成員之申索人*。僱主供款累算權益的僱員歸屬部分(「歸屬權益」)對減此款額或僱員之歸屬權益,以較低者為準。僱主現要求受託人退還港幣 元正予僱主。Note:If no supporting document is provided by the employer, please request the respective member/claimant of a deceased member to sign below to
acknowledge receipt of LSP/SP as stated above. Otherwise, it will be deemed that no reimbursement from the Trustee is required.
註:如僱主未能提交任何證明文件,請要求有關成員/去世成員之申索人於下面簽署以確認其已收妥由僱主發放上述款額之長期服務金/遣散費。否則,受託人將當作僱主無退款需要。
I agree and acknowledge receipt of the LSP/SP* amount stated above
本人同意及確認已收妥上述之長期服務金/遣散費*
Signature of Member / Claimant*
成員/申索人*簽署
Date (ccyy/mm/dd)
日期(年/月/日)
Important Notice 重要事項:
1. Please be reminded that the employer must settle all outstanding contribution in respect of the terminated member before LSP/SP can be reimbursed.請緊記僱主必須於退還長期服務金/遣散費前就離職成員清繳所有未繳付之供款。
2. If the signature of member is not the same as filed with AIAPT, employer may be requested to provide appropriate supporting documents.
若成員之簽署與已備存於友邦退休金之記錄不符,僱主可能被要求提供相關的證明文件。
3. Once the employer has declared his option on the LSP/SP reimbursement, any subsequent amendment will not be accepted.
僱主一經對是否提出退還長期服務金/遣散費之申索作出聲明,其後任何更改恕不受理。
4. In the event of a death case, please attach a copy of the death certificate and supporting documents to prove the identity of the claimant of thedeceased member and their relationship.
如遇上死亡事故,請連同去世成員之死亡證、申索人之身份證明文件及與去世成員之關係證明文件副本一併遞交。 Name of Member / Claimant*成員/申索人*姓名
Please fill in the following and submit the “Occupational Retirement Scheme Notification of Member Termination” if this terminating member alsoparticipates in an ORSO Scheme with AIA Pension and Trustee Co. Ltd.
若此離職成員同時參與美國友邦退休金管理及信託有限公司之職業退休計劃,請填寫此欄及就有關成員遞交「職業退休計劃成員離職通知書」。Scheme No. 退休金計劃號碼Participant No. 參與編號
5. Please select one of the following options if Long Service Payment (LSP) / Severance Payment (SP) reimbursement is required and/or if the
member is entitled to the employer’s voluntary contribution.
如需要退還長期服務金/遣散費及/或成員有權享有僱主之自願性供款,請選擇以下其中一項。Reason for cessation of employment (Please tick one of the following) 離職原因 (請 Ö 以下其中一項):
(Note: If no option is being selected, the termination reason will be deemed as “Resignation”.)
(註: 如沒有作出任何選擇,則以 é辭職û 作為既定處理方法。)qqqResignation 辭職Death 死亡qqRetirement (Early/Normal/Late*) 退休(提早/正常/延遲*)qTotal incapacity 完全喪失行為能力
Redundancy / Lay-off / Termination of employment / Dismissal 裁員/停工/終止受僱/解僱
Summary dismissal (please complete the following) 因嚴重過失而被解僱 (請填妥以下資料)If the member is dismissed by cause, is the member entitled to employer’s voluntary balance? (Please tick one of the following)
如成員被解僱,成員是否仍可有權享有僱主之自願性供款?(請 Ö 以下其中一項)q Zero percentage (i.e. default treatment per the Principal Brochure) 零百份比 (即《主要說明書》內之既定處理方法)q According to existing vesting scale 按照現有權益歸屬比例q Others (please specify %) 其他 (請註明百分比):We confirm that we have read, understood and agreed to the declaration clauses stated below.
吾等確認已參閱,瞭解及同意下列之聲明。
Authorised signature
授權人簽署Company chop公司印鑑Date (ccyy/mm/dd)日期(年/月/日)
Declaration by the Employer 僱主聲明
I/We hereby declare and agree that any personal information collected or held by the Trustee (whether contained in this form or otherwise obtained) isprovided and may be held, used, and disclosed by the Trustee to individuals/organisations associated with the Trustee or any selected third party(within or outside Hong Kong), for the purposes of processing this form and providing subsequent services for this. I/We understand that (i) I am/weare duly authorised to release the information of my/our employees and will fully indemnify the Trustee for any losses, damages, or claims that mightresult from the release of such information; (ii) the Trustee may be unable to process this form if I/we fail to provide any information requested in thisform; and (iii) I/we have the right to obtain access to and to request correction of any personal information held by the Trustee concerning my/ouremployees. Such request can be made to the Trustee.
I/We confirm that the information of my/our employees which I/we provide to the Trustee has been verified. I/We agree to indemnify and keep theTrustee indemnified against any and all losses, cost, expenses, actions, proceedings suffered by the Trustee as a result of any inaccuracy of theinformation provided for the purpose of processing this termination and reimbursement request (where applicable). We agree that in case of anydispute between our employee(s) and us relating to the terms of the termination of employment and/or MPF scheme membership of the employee(s)concerned, we will assume full responsibility in resolving such dispute.
I/We hereby authorise the Trustee to accept, process, execute and rely upon instructions issued in my/our names and my/our signatures and sent tothe Trustee by original copy only. I/We agree to be bound by the said instructions sent to the Trustee under my/our names and my/our signatures andI/we further agree to indemnify and hold the Trustee harmless from and against any and all liability and expense incurred by the Trustee arising fromthe Trustee’s execution of the said instructions.
本人/吾等謹此聲明並同意,受託人可保留、使用或透露受託人所收集或保留的任何有關申請人的個人資料(在此表格所載或從其他途徑取得),給予與受託人有關人士或公司或任何被選定的機構(在本港或海外),用作處理本文件及其售後服務。本人/吾等明白:(i)本人/吾等獲授權公開本公司僱員之資料,並賠償受託人因公開有關資料所導致之任何損失、損壞及申索。(ii)倘若本人/吾等未能提供本表格所需的資料,受託人將可能無法處理有關表格,及(iii)本人/吾等有權向受託人查閱及要求修正備存於受託人的有關本人/吾等僱員的個人資料,有關要求可向受託人提出辦理。
本人/吾等確認其提交予受託人之有關本人/公司之僱員資料已核對無誤,倘若因本人/吾等所填報之資料錯誤,而導致受託人在處理有關此僱員之離職及退款申索(如適用)個案中蒙受任何損失、支出、或須要進行任何行動或訴訟,本人/吾等同意作出有關賠償予受託人。吾等同意倘若吾等與僱員間因有關僱員之離職及/或終止有關僱員於強制性公積金計劃內的成員資格之條款而產生爭議,吾等自當負責解決有關之爭議。
本人/吾等謹此授權受託人依據以本人/吾等名義簽署及送往受託人之正本所指示以接納、處理及執行有關事宜。本人/吾等同意受本人/吾等名義簽署之指示約束,並且同意賠償受託人因執行所述指示而致產生之任何後果及其責任與支出。本人/吾等亦同意確保受託人不因此而蒙受任何損失。