To : HSBC Provident Fund Trustee (Hong Kong) Limited c/o HSBC Life (International) Limited PO Box 73770 Kowloon Central Post Office 73770
HSBC MANDATORY PROVIDENT FUND – SUPERTRUST EMPLOYEE APPLICATION FORM (EMPLOYEE)
IN51
Note 1. This application is issued in conjunction with the Principal Brochure. 2. Membership certificate will be issued to members within 60 days from the enrollment to the MPF scheme. 60 3. Please complete in BLOCK LETTERS and tick ✓ the appropriate box(es). ✓ 4. If you have provided a PO Box as your correspondence address under Section B8 of Part I below, please state your residential address in additional sheet. B8 5. Please return the completed form (Part I and Part II) to the Administrator HSBC Life (International) Limited PO Box 73770 Kowloon Central Post Office. 73770
PART I – MEMBER SECTION (to be completed by member ) A. Participating employer name 1. Participating employer name (in English)
B. Details of applicant 2. English Name Surname
Given name
3. Chinese Name
4. HKID Card/Passport No.Note 1 1
Place of issueNote 1 1
7.
Sex
()
6. Date of BirthNote 2 2 Year
8.
5.
Male
Month Day
Female
Correspondence address (in English) (The field must be completed ) This correspondence address will automatically apply to ALL your accounts maintained with HSBC MPF under the HKID/Passport number stated above. If you wish to change the correspondence address for a specific account, please complete the 'Personal Details Change Form' (IN91). (IN91)
Flat/Room
Building
Floor
Block
Estate
Street HK
NT
KLN
Others
District/Country (if not in Hong Kong) 9.
Day time contact no.
10. Facsimile no.
11. Mobile phone no.
12. E-mail address
English
Chinese
Note 1 1
Passport number should be given only if you do not possess HKID card. Please also enclose a copy of your passport and provide the place of issue.
Note 2 2
If your HKID card only contains the year and you have no other form of identity to prove the exact date of birth (e.g. birth certificate, passport), you should use 31 December as the day and month. Likewise, if your HKID card contains the year and month but not the day, you should use the last day of the month shown. If you leave the day and/or month blank, your date of birth will be regarded as the last day of that month or 31 December. 1231 1231 1 of 3
IN51 v09/0110 (0110) D
13. Preferred language for future correspondence
C. Initial investment option Please indicate into which of the SuperTrust funds you would like to invest your contributions and transferred monies (if any). The investment allocation percentage should be in whole numbers (e.g. 50% not 50.5%) and the total should be 100%. If the total allocation is not 100%, or if this section is left blank, all amounts will be fully invested into the MPF Conservative Fund. 50% 50.5% 100% 100% Name of investment fund
Investment allocation percentage
MPF Conservative Fund
CPF
%
Guaranteed Fund *
GTF
%
Balanced Fund
BLF
%
Growth Fund
GRF
%
Hang Seng Index Tracking Fund
HSIF
%
Total
100 %
* For information about the Guaranteed Interest Rate, please visit www.hsbc.com.hk/mpf or call our Customer Service Representative on 2238 0088. www.hsbc.com.hk/mpf 2238 0088
D. Personal data statement Personal data provided by Participating Employers and Members of SuperTrust and SuperTrust Plus on application forms and details of transactions or dealings by such Participating Employers or Members may be used, disclosed and transferred (in and outside the Hong Kong Special Administrative Region) to such persons as the Trustee or any service provider may consider necessary, including regulators and government authorities in any jurisdiction and any entity of the HSBC Group for any purpose in connection with the services they may provide to the Participating Employers and Members, including provident fund, banking, insurance and related financial services, and/or in connection with matching for whatever purpose with other personal data concerning the relevant Participating Employers or Members and/or for the purpose of promoting, improving and furthering the provision of services by entities of the HSBC Group to their customers generally. Participating Employers and Members have a right to request access to and correction of any personal data or to request that personal data about them not be used for direct marketing purposes. Requests can be made in writing to the Data Protection Officer, HSBC Provident Fund Trustee (Hong Kong) Limited, c/o HSBC Life (International) Limited, PO Box 73770 Kowloon Central Post Office. 73770c/o HSBC Provident Fund Trustee (Hong Kong) Limited
E. Declaration and authorisation Participation — by signing this form, I a) understand that the investment allocation as specified in Section C will be applied to all contributions including any monies transferred into SuperTrust and C b) declare I have read and understood the Principal Brochure, and c) agree to comply with the Master Trust Deed of the scheme, and d) confirm having read and understood the Personal data statement in Section D, and D e) authorise the Participating Employer to deduct mandatory contribution and additional voluntary contribution (if applicable) from my relevant income and remit them to the Trustee.
X Signature of employee
Full name
Date
(This signature will be used to verify your future correspondence to us )
2 of 3
IN51 v09/0110 (0110) D
NOTES: This form MUST BE RETURNED to your employer to complete “Part II – Employer Section”
PART II – EMPLOYER SECTION (to be completed by employer ) A. Employee employment details 1. Employer ID
2.
Employee’s date of employment
3. Class ID
4.
Pay Centre ID
Year
Month Day
B. Employee type Please tick ✓ the appropriate box. If this section is left blank, the member will be assumed as neither a casual employee nor an expatriate employee. ✓ 5. Casual employees
No
Yes
6. Expatriate employee
No
Yes
(if “yes”, please advise visa issue date and arrival date in Hong Kong respectively ) Visa issue date
Year
Arrival date in Hong Kong
Month Day
Year
Month Day
C. Employment related information Please tick ✓ the appropriate box and select ONE only. If this section is left blank, the member will be assumed as a newly enrolled member. ✓ Newly enrolled member Member transferring from MPF Exempted ORSO Scheme Date joined an MPF scheme of the employer
Year
Month Day
Employer scheme transfer – member transferring from another MPF scheme due to change of scheme service provider by current employer Date first joined an MPF scheme of the employer
Year
Month Day
Effective date of transfer
Year
Month Day
Member transfer – member transferring from another MPF scheme due to change of employment between associated companies or change of business ownership First date joined employer group# # #
Year
Month Day
Years of service for the calculation of the member’s vesting entitlement will be counted from the above date.
D. Personal data statement Personal data provided by Participating Employers and Members of SuperTrust and SuperTrust Plus on application forms and details of transactions or dealings by such Participating Employers or Members may be used, disclosed and transferred (in and outside the Hong Kong Special Administrative Region) to such persons as the Trustee or any service provider may consider necessary, including regulators and government authorities in any jurisdiction and any entity of the HSBC Group for any purpose in connection with the services they may provide to the Participating Employers and Members, including provident fund, banking, insurance and related financial services, and/or in connection with matching for whatever purpose with other personal data concerning the relevant Participating Employers or Members and/or for the purpose of promoting, improving and furthering the provision of services by entities of the HSBC Group to their customers generally. Participating Employers and Members have a right to request access to and correction of any personal data or to request that personal data about them not be used for direct marketing purposes. Requests can be made in writing to the Data Protection Officer, HSBC Provident Fund Trustee (Hong Kong) Limited, c/o HSBC Life (International) Limited, PO Box 73770 Kowloon Central Post Office. 73770c/o HSBC Provident Fund Trustee (Hong Kong) Limited
X For office use only
Date of application (yyyy/mm/dd)
Full name
BCC
Date
Enrol staff code
Data checked by
Input checked by
Please return the form to HSBC Provident Fund Trustee (Hong Kong) Limited c/o HSBC Life (International) Limited PO Box 73770 Kowloon Central Post Office 73770 3 of 3
IN51 v09/0110 (0110) D
Authorised signature of employer
