To 致: HSBC Provident Fund Trustee (Hong Kong) Limited

c/o The Hongkong and Shanghai Banking Corporation Limited 香港上海滙豐銀行有限公司

PO Box 73770 Kowloon Central Post Office 九龍中央郵政信箱73770號
or 或
Place into the MPF drop-in box at designated HSBC branches
投放於指定滙豐分行的強積金寄存辦理箱
HSBC MPF Employer Hotline 滙豐強積金僱主熱線：2583 8033
HSBC MPF Member Hotline 滙豐強積金成員熱線：3128 0128 IN54
HSBC MANDATORY PROVIDENT FUND
PARTIAL WITHDRAWAL REQUEST FORM (EMPLOYEE)
IN54
滙豐強積金：提取部分結餘申請表（僱員）

MPF is designed to assist with you planning for retirement and should not generally be regarded as a
source of funds for meeting short-term financial needs. We would therefore encourage you to consider
your long-term financial needs for retirement before withdrawing your funds from your MPF account. 強
積金是為助你計劃退休而設，所以不應普遍被視作應付短期財務需要的資金來源。故此，我們希望你在提取強積金賬戶款
項之前，先考慮你退休時的長遠財務需要。

Note 注意：
1. Please complete in CAPITAL and BLOCK LETTERS and tick  the appropriate box(es). 請用大楷及正楷填寫，並於適當的方格內加上「」號。
2. This form is for use by employee for the purpose of making a request to withdraw non-mandatory contribution balances. 此表格適用於僱員申請提取非強制性供款結餘。
3. Please provide a certified true copy of your HKID card, if this was not previously provided or if there has been any change of information contained in your HKID card. If
you are NOT a holder of a HKID card, please provide a certified true copy of your passport. 若以往未曾提供或資料已變更，請提供你的香港身分證之認證副本。如你非持有
有效的香港身分證，請提供你的護照之認證副本。
4. Certified true copies should be certified by any of the following personnel 提交認證副本可經由下列人士核證：
— A certified public accountant/lawyer/banker/notary public acceptable to entities of HSBC Group; or 任何滙豐集團成員認可的執業會計師╱律師╱往來銀行╱公證人；
或
— A member of Hong Kong Institute of Chartered Secretaries (HKICS); or 任何香港特許秘書公會會員；或
— A MPF specialist at HSBC designated branches – You may bring along your HKID card/passport to any one of HSBC designated branches for verification purpose. For
the information about the HSBC designated branches, please visit . 指定滙豐分行強積金職員 – 你可攜同你的香港身分證╱護照親臨任何一間
指定滙豐分行，以便我們核實你的身分。查詢指定滙豐分行詳情，請瀏覽 。
5. The information provided will be used in accordance with the relevant MPF Ordinance and/or its Regulations and the same manner as mentioned in the “Personal
Information Collection Statement for HSBC Mandatory Provident Fund” (“PICS”). The PICS can be obtained through HSBC MPF website
or MPF hotline 2583 8033 (Employer) or 3128 0128 (Member). By signing this form, your present choice of receiving direct marketing information will remain
unchanged. If you wish to update the use of your personal data for direct marketing purpose as stated in the PICS from the HSBC MPF scheme, you may
exercise your right by notifying us. 所 有 已 提 供 的 資 料 將 按 照 有 關 強 積 金 條 例 及 ╱ 或 其 規 例 及《滙 豐 強 積 金 的 收 集 個 人 資 料 聲 明》（「聲 明」）處 理 。 該 聲
明可透過以下滙豐強積金網站 或 強 積 金 熱 線2583 8033（僱 主）或3128 0128（成 員）索 取 。 在 簽 署 本 表 格 後 ， 你 現 時 關 於 接 收 直 接
促銷資訊的選擇將維持不變 。 如你希望更新在滙豐強積金計劃聲明中使用你的個人資料作直接促銷的用途 ， 你可通知我們行使你的選擇權 。

A. Personal information 個人資料

1. Full name 全名（same as that shown on your 2. HKID/Passport no. 香港身分證╱護照號碼 3. Employer ID 僱主編號
HKID card/Passport 與香港身分證╱護照上的
姓名相同）

4. Company name of participating employer 參與僱主公司名稱 5. Pay Centre ID 付款中心編號

B. Withdrawal of funds 提取款項

Withdrawal percentage 提取百分比
Name of sub-account 賬目名稱
(must be in whole number 必須為整數 )

1. Member’ s voluntary contributions 成員自願性供款

If any part of your member’ s voluntary contributions are made according to an arrangement
pre-set by your employer together with employer’ s voluntary contributions, your employer’ s
written consent in Section D is required for withdrawal of these funds (unless your employer has %
previously informed us in writing that their approval is not required). 如你的成員自願性供款中，
部分供款乃根據僱主預設的協定連同僱主自願性供款同時作出，則提取此款項須獲得僱主於 D 部作出
書面同意（除非你的僱主曾以書面通知我們不須獲得他們的同意）。

2. Member’ s ORSO transfers 成員的職業退休計劃轉移款項

Your employer’ s written consent in Section D is required for withdrawal of these funds. %
你必須獲得僱主於 D 部作出書面同意，方可提取此款項。

3. MPF non-preserved transfers 毋須保存的強積金轉移款項 %

IN54 v16/0423 (0423) H

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To 致: HSBC Provident Fund Trustee (Hong Kong) Limited
c/o The Hongkong and Shanghai Banking Corporation Limited 香港上海滙豐銀行有限公司
PO Box 73770 Kowloon Central Post Office 九龍中央郵政信箱73770號
or 或
Place into the MPF drop-in box at designated HSBC branches
投放於指定滙豐分行的強積金寄存辦理箱
HSBC MPF Employer Hotline 滙豐強積金僱主熱線：2583 8033
HSBC MPF Member Hotline 滙豐強積金成員熱線：3128 0128 IN54
HSBC MANDATORY PROVIDENT FUND
PARTIAL WITHDRAWAL REQUEST FORM (EMPLOYEE)
IN54
滙豐強積金：提取部分結餘申請表（僱員）

MPF is designed to assist with you planning for retirement and should not generally be regarded as a
source of funds for meeting short-term financial needs. We would therefore encourage you to consider
your long-term financial needs for retirement before withdrawing your funds from your MPF account. 強
積金是為助你計劃退休而設，所以不應普遍被視作應付短期財務需要的資金來源。故此，我們希望你在提取強積金賬戶款
項之前，先考慮你退休時的長遠財務需要。

Note 注意：
1. Please complete in CAPITAL and BLOCK LETTERS and tick  the appropriate box(es). 請用大楷及正楷填寫，並於適當的方格內加上「」號。
2. This form is for use by employee for the purpose of making a request to withdraw non-mandatory contribution balances. 此表格適用於僱員申請提取非強制性供款結餘。
3. Please provide a certified true copy of your HKID card, if this was not previously provided or if there has been any change of information contained in your HKID card. If
you are NOT a holder of a HKID card, please provide a certified true copy of your passport. 若以往未曾提供或資料已變更，請提供你的香港身分證之認證副本。如你非持有
有效的香港身分證，請提供你的護照之認證副本。
4. Certified true copies should be certified by any of the following personnel 提交認證副本可經由下列人士核證：
— A certified public accountant/lawyer/banker/notary public acceptable to entities of HSBC Group; or 任何滙豐集團成員認可的執業會計師╱律師╱往來銀行╱公證人；
或
— A member of Hong Kong Institute of Chartered Secretaries (HKICS); or 任何香港特許秘書公會會員；或
— A MPF specialist at HSBC designated branches – You may bring along your HKID card/passport to any one of HSBC designated branches for verification purpose. For
the information about the HSBC designated branches, please visit . 指定滙豐分行強積金職員 – 你可攜同你的香港身分證╱護照親臨任何一間
指定滙豐分行，以便我們核實你的身分。查詢指定滙豐分行詳情，請瀏覽 。
5. The information provided will be used in accordance with the relevant MPF Ordinance and/or its Regulations and the same manner as mentioned in the “Personal
Information Collection Statement for HSBC Mandatory Provident Fund” (“PICS”). The PICS can be obtained through HSBC MPF website
or MPF hotline 2583 8033 (Employer) or 3128 0128 (Member). By signing this form, your present choice of receiving direct marketing information will remain
unchanged. If you wish to update the use of your personal data for direct marketing purpose as stated in the PICS from the HSBC MPF scheme, you may
exercise your right by notifying us. 所 有 已 提 供 的 資 料 將 按 照 有 關 強 積 金 條 例 及 ╱ 或 其 規 例 及《滙 豐 強 積 金 的 收 集 個 人 資 料 聲 明》（「聲 明」）處 理 。 該 聲
明可透過以下滙豐強積金網站 或 強 積 金 熱 線2583 8033（僱 主）或3128 0128（成 員）索 取 。 在 簽 署 本 表 格 後 ， 你 現 時 關 於 接 收 直 接
促銷資訊的選擇將維持不變 。 如你希望更新在滙豐強積金計劃聲明中使用你的個人資料作直接促銷的用途 ， 你可通知我們行使你的選擇權 。

A. Personal information 個人資料

1. Full name 全名（same as that shown on your 2. HKID/Passport no. 香港身分證╱護照號碼 3. Employer ID 僱主編號
HKID card/Passport 與香港身分證╱護照上的
姓名相同）

4. Company name of participating employer 參與僱主公司名稱 5. Pay Centre ID 付款中心編號

B. Withdrawal of funds 提取款項

Withdrawal percentage 提取百分比
Name of sub-account 賬目名稱
(must be in whole number 必須為整數 )

1. Member’ s voluntary contributions 成員自願性供款

If any part of your member’ s voluntary contributions are made according to an arrangement
pre-set by your employer together with employer’ s voluntary contributions, your employer’ s
written consent in Section D is required for withdrawal of these funds (unless your employer has %
previously informed us in writing that their approval is not required). 如你的成員自願性供款中，
部分供款乃根據僱主預設的協定連同僱主自願性供款同時作出，則提取此款項須獲得僱主於 D 部作出
書面同意（除非你的僱主曾以書面通知我們不須獲得他們的同意）。

2. Member’ s ORSO transfers 成員的職業退休計劃轉移款項

Your employer’ s written consent in Section D is required for withdrawal of these funds. %
你必須獲得僱主於 D 部作出書面同意，方可提取此款項。

3. MPF non-preserved transfers 毋須保存的強積金轉移款項 %

IN54 v16/0423 (0423) H

1 of 2
C. Method of payment 付款 方式 (please ✓ the appropriate box 請在 適當的方格內填上✓號)
a) The direct deposit service is only available for bank account with sole account holder. For verification purpose, please provide
supporting document which shows bank account number and name of account holder, such as copy of bank statement, copy of
bank ATM card or copy of bank reference letter etc. If the relevant supporting document is not provided, the administrator of HSBC
MPF scheme is unable to proceed with direct deposit to your bank account and the method of payment will be changed to be by
cheque without prior notice. 直接 存入 銀行賬 戶服務只 適用於 你 以個人名義 獨立持 有的銀行賬 戶。請提 供能 顯示你銀行賬 戶號碼及持 有
人名稱的文件 作核 實用途，例如銀行月結單副 本、銀行提 款卡副 本或 銀行信件副 本 等。如未能 提 供 有關文件，滙 豐強 積 金計劃行政 管理
人不能 提 供 直接 存入 銀行賬 戶服務，而付款 方式 將轉 為以 支 票付款 及不作另行 通 知。

b) If this section is left blank or the information is incomplete, this form may not be processed. 如此部分留空或資料 不完整，本表格可能不獲 處理。

 by depositing directly into a bank account under the sole name of scheme member only 直接存入只以計劃成員名義開立的銀行賬戶 (If you choose
to have the benefits to be paid to your other local bank (except for HSBC in Hong Kong or Hang Seng Bank in Hong Kong) or overseas bank account
directly, bank charges may apply by your banking account. 如你選擇將權益 直 接匯入 其他 本 地 銀 行（香 港 滙 豐或香 港恒生 銀 行除外）或 海 外 銀
行賬 戶，則該銀 行可透 過你的銀 行賬 戶收取 銀 行手續費。)

Name of bank account holder 銀 行賬 戶持有人 姓名：

Name of bank 銀 行名稱 ： □ HSBC in Hong Kong 香 港 滙 豐
□ Hang Seng Bank in Hong Kong 香 港恒生 銀 行
□ Other local bank, please specify 其他 本 地 銀 行，請註明：

□ Overseas bank, please specify 海 外 銀 行，請註明：

Bank account number 銀 行賬 戶號碼：

For overseas bank only 只適 用於海 外 銀 行：

(i) Address of bank 銀 行 地 址：

(ii) Swift code Swift編號：

(iii) Currency 貨幣：

(iv) IBAN 受款 人 戶口號碼：

 by cheque 支票

D. Employer’ s authorisation 僱主授權書 (where applicable 如適用 )

I/We hereby authorise the above employee to withdraw Member’ s voluntary contributions and/or Member’ s ORSO transfers as stated in
Section B. 本人（等）現授權以上僱員提取填寫於 B 部的成員自願性供款及╱或成員的職業退休計劃轉移款項。

Authorised signature of employer Authorised signature of employer Company chop

僱主授權簽署 僱主授權簽署 公司蓋章

x x
Full name 全名 Full name 全名 Date 日期

E. Declaration and authorisation 聲明及授權書

By signing this form, I:
在簽署本表格後，本人：
a) understand that my partial withdrawal request will only be processed if all of the following conditions are met:
明白提取部分結餘的申請只會在符合以下所有條件的情況下才可獲得處理：
* The total withdrawal amount is HK$5,000 or more;
提取之總額不少於港幣 5,000 元；
* The withdrawal request is within the withdrawal limit of 12 times per scheme financial year;
此提取申請乃不超逾每個計劃財政年度最多 12 次之限制；
* My employer's consent is obtained, if required.
已獲得僱主同意（如需要）。
b) understand that the guarantee will not apply to withdrawal of funds invested in the Guaranteed Fund, unless any one of the Guarantee
Conditions is met. Please refer to the ‘MPF Scheme Brochure’ for details of the ‘Guarantee Conditions’ . 明白除符合任何一項保證條件外，保證
將不適用於提取投資於保證基金的款項。有關「保證條件」，請參閱「強積金計劃說明書」。
c) understand that where fund units are held in different investment funds, the same withdrawal percentage will be redeemed from each fund.
明白如有基金單位於不同的投資基金內，則每個基金均會按提取百分比贖回基金單位。
d) have read and understood the full details of this form (including the Notes on this form) and agree to abide by the rules stated herein. 已細閱及
明白此表格內的所有內容（包括此表格上的注意部分），並同意遵守此述的規則。

x
IN54 v16/0423 (0423) H

Member's signature 成員簽署 Date 日期

(This signature must be the same as your previous specimen submitted to us. Otherwise, this form may not be processed. 此簽名須與你之前遞交
予我們的式樣相同，否則本表格可能不獲處理。)

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