Statutory Declaration For Claims For Payment

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Annex D to IV.4
FORM MPF(S) - W(SD2)
MANDATORY PROVIDENT FUND SCHEMES ORDINANCE (CAP. 485)
(“the Ordinance”)
STATUTORY DECLARATION FOR CLAIMS FOR PAYMENT
OF ACCRUED BENEFITS ON GROUND
OF PERMANENT DEPARTURE FROM HONG KONG
 WARNINGS:
Under section 43E of the Ordinance, a person who, in any document given to the
(1)
Mandatory Provident Fund Schemes Authority (“the Authority”) or an approved trustee,
knowingly or recklessly makes a statement which is false or misleading in a material
respect commits an offence and is liable to a maximum penalty of a $100,000 fine
and 1 year’s imprisonment on the first conviction and a $200,000 fine and 2 years’
imprisonment on each subsequent conviction. A person who knowingly or willfully
makes a statutory declaration false in a material particular also commits an offence
under section 36 of the Crimes Ordinance (Cap. 200) and is liable on conviction to
imprisonment for 2 years and to a fine.
A scheme member who makes a false or misleading statement to the approved trustee for
(2)
early withdrawal of accrued benefits on the ground of permanent departure from Hong
Kong is liable to prosecution.
A scheme member is entitled to be paid accrued benefits on the ground of permanent
(3)
1
departure from Hong Kong only once in a lifetime
, except as permitted by the
2
Mandatory Provident Fund Schemes (General) Regulation (“the Regulation”)
. A
scheme member who makes a false or misleading statement to the approved trustee that
he/she has not previously been paid accrued benefits on an earlier departure date is liable
to prosecution.
The Authority has kept a register of all claimants to verify if anyone has previously been
(4)
paid accrued benefits on the same ground using an earlier departure date.
1.
I have read the above warnings and fully understand that:
(a)
I am entitled to be paid accrued benefits on the ground of permanent departure
1
2
from Hong Kong only once in a lifetime
, except as permitted by the Regulation
;
and
(b)
making a false or misleading statement to the approved trustee for early withdrawal
of accrued benefits on the ground of permanent departure from Hong Kong is liable
to prosecution.
1
Section 163(3) of the Regulation provides that a person who has been paid accrued benefits from a registered
scheme on the ground that, on a specified date, the person has departed, or was about to depart, from Hong
Kong permanently is not, before reaching the retirement age, entitled to be paid the member’s accrued benefits
from the same or another registered scheme on the ground that, on a later date, the person purports to have
departed, or to be about to depart, from Hong Kong permanently.
2
Section 163(6) of the Regulation provides that if accrued benefits held in an account of a member of a
registered scheme have been paid to the member on the ground that, on a specified date, the member has
departed, or was about to depart, from Hong Kong permanently, the member is not, before reaching the
retirement age, precluded from making a further claim on the ground of permanent departure on that specified
date if the claim is for the payment of other accrued benefits of the member held in another account in that
scheme, or for the payment of other accrued benefits of that member in another registered scheme.
Version 12 – February 2016

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