FIDELITY RETIREMENT MASTER TRUST 富达退休集成信托

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1、FORMMPF(S)–P(M)FIDELITYRETIREMENTMASTERTRUST富達退休集成信託Note1SCHEMEMEMBER’SREQUESTFORFUNDTRANSFERFORM註1計劃成員資金轉移申請表Notes:(1)PleasereadtheexplanatorynotescarefullybeforecompletingthisForm.填報本申請表前，請先細讀填報須知。(2)DefinitionoftermsisprovidedatExplanatoryNote2.用詞定義載於填報須知註2。(3)Pleaseuseblueorblackballpointp

2、enandcompletethisForminblockletters;anyamendmentsshouldbeclearlymarkedandcounter-signed.Pleasedonotusecorrectionfluid.請以藍色或黑色原子筆及正楷填寫此表格。如有任何資料刪改請必須加簽,請避免用塗改液刪改資料。(4)*meansdeletewhicheverisinappropriate*請刪去不適用者。(5)Pleaseinsert"N.A."ifnotapplicable.請在不適用處填上「不適用」。(6)Theinformationanddataprovided

3、inthisFormcanbeusedbytheapprovedtrusteesconcernedandtheMandatoryProvidentFundSchemesAuthorityinactivitiesrelatingtotheprocessingofthetransferandmaybedisclosedtootherpartiesforsuchpurposes.本申請表所載資料及數據可供有關的核准受託人及強制性公積金計劃管理局作處理轉移的用途，並可為此用途向其他人士披露。(7)ShouldyouhaveanyquestionswhencompletingthisForm

4、,pleasefeelfreetocontacttheFidelityRetirementHotlineat2500-1666.如閣下於填表時有任何疑問，請致電富達退休投資熱線2500-1666。(8)PleaseseeprocedurestobefollowedinExplanatoryNote7aftercompletionofthisForm.填妥本表格後，請參閱填報須知第(7)項以了解遞表安排。SECTIONI-DETAILSOFTHESCHEMEMEMBER第I部-計劃成員資料(1)Nameoftheschememember:計劃成員姓名：(Mustbeidentical

5、tothenameprintedonyourHKIDCard/Passport成員姓名須與身分證/護照相同)Note3(2)HKIdentity(HKID)Card/Passport*no.oftheScheme註3Member計劃成員香港身分證/護照*號碼：(MustbeidenticaltotheoneontheMembershipEnrollmentForm須與計劃成員登記表格的身分證/護照號碼相同)(3)Correspondenceaddress通訊地址Flat/Room室Floor樓/層Block座Nameofbuilding大廈Streetno.街/道號碼Nameofs

6、treet街/道HongKong香港/Kowloon九龍/N.T.新界*Nameofdistrict區(4)ContactPhoneNumber聯絡電話號碼：(5)Mobile/Pagerno.手提電話/傳呼機號碼：(6)Facsimileno.傳真號碼：(7)E-mailaddress電郵地址：(PleaseprovideONEemailaddressonly請只填寫一個電郵地址)HSBCInstitutionalTrustServices(Asia)Limited滙豐機構信託服務(亞洲)有限公司HTHK/FORM/MPF/FIL/FundTransferFormMPF(S)-P

7、(M)(0405)1SECTIONII-FUNDTRANSFERINFORMATION第II部-資金轉移資料Detailsoftheaccountfromwhichaccruedbenefitsderivedfrommandatorycontributionsaretobetransferred就要求轉移由強制性供款衍生的累算權益所屬的帳戶資料：NameoftheTrustee受託人名稱：HSBCInstitutionalTrustServices(Asia)Limi