基於已达到65岁退休年龄或提早退休的理由而申索累算权益的

1、 This form is to be completed by any person who wishes to claim for payment of accrued benefits from a registered scheme on the ground of attaining the retirement age of 65 or early retirement (i.e. must reach the age of 60 and have permanently ceased all employment and self-employment with no intention of becoming employed or self-employed again) only. For a claim for payment of accrued benefits on other grounds, please use Form MPF(S) W(O). Accrued benefits may be withdrawn either in a lump su

2、m or by instalments. The scheme member may be charged the necessary transaction costs for each withdrawal. If the claimant/scheme member wishes to withdraw accrued benefits from more than one registered scheme, please fill in a separate form for each registered scheme. Withdrawal of accrued benefits derived from voluntary contributions is subject to the governing rules of the registered scheme concerned. Please refer to the latest Principal Brochure of the Fidelity Retirement Master Trust (“the

3、Scheme”) which can be obtained from Fidelity Website .hk or consult with the relevant approved trustee for information. Please read the explanatory notes and the Personal Data (Privacy) Ordinance Notice carefully before you complete this form. The personal data to be supplied in support of this claim for payment of accrued benefits are to be used for processing your claim. The personal data you supply may, for such purpose, be transferred to the relevant service provider(s) and the government or

4、 regulatory bodies including the Mandatory Provident Fund Schemes Authority (“Authority”). Please complete this form in block letters and the appropriate box. Please do not use correction fluid and all amendments should be signed. Please complete the compulsory fields of personal information marked (). The execution of instructions may be delayed if compulsory fields are incomplete or incorrect. If any information provided is incorrect or incomplete, the relevant approved trustee may not be able

5、 to process your request. Your instruction will be delayed if any of the following transactions is/are in progress, (i) asset switching; (ii) withdrawal due to claim of accrued benefits, transfer of benefits under Employee Choice Arrangement (“ECA transfer“), refund of long service/severance payment or refund of contribution ; (iii) any redemption or transfer of benefits request; or (iv)the annual de-risking of your investments in the Default Investment Strategy (“DIS”). Please send the complete

6、d form and the required supporting documents to Member Services, Fund Services Hong Kong, HSBC Institutional Trust Services (Asia) Limited, P.O. Box 73448, Kowloon Central Post Office, Hong Kong. 本表格謹供擬基於已達到65歲退休年齡或提早退休（必須達到60歲，並已永久性地終止所有受僱及自僱工作，且無意再次受僱 或自僱）的理由而要求從一個註冊計劃申索累算權益的人士填報。若基於其他理由要求申索累算權益，請填寫第MPF(S)W(O)表 格。 申索累算權益可選擇整筆提取或分期方式提取。核准受託人可就每次提取向計劃成員收取必需交易費用。如申索人/計劃成員擬從多 於一個註冊計劃提取累算權益，須就每個註冊計劃填寫一份表格。 提取由自願性供款所產生的累算權益，須受有關註冊計劃的管限規則所規限。您可於富達網站.hk查閱富達退 休集成信託（計劃）的最新主要推銷刊物或向有關核准受託人查詢。 在填報本表格前，請先細閱

7、填報須知及個人資料（私隱）條例通知。 就此項申索累算權益申請提供的個人資料，將用作處理你的申索。你提供的個人資料可能會為該目的而轉交相關服務提供者 及政府或規管機構，包括強制性公積金計劃管理局（管理局）。 請以正楷填寫此表格並在適用的空格填上 號。請勿使用塗改液，任何刪改必須加簽。所有以（）標記為必須填寫的個人 資料。如必須填寫項目為不完整或不正確，此指示將可能被延誤執行。 若提供的任何資料不正確或不完整，有關的核准受託人可能無法處理您的申請。 若有任何下列的交易仍在處理中，您的指示將會被延誤處理（i）資產轉換；（ii）因累算權益的申索，僱員自選安排轉移(“ECA 轉移“)，退還長期服務金/遣散費或退還供款之提取交易；（iii）任何贖回或權益轉移指示；或（iv）預設投資策略下按年降低 您的投資風險。 請將填妥表格及所需證明文件寄往香港九龍中央郵政局郵政信箱73448號，滙豐機構信託服務（亞洲）有限公司，退休金行 政部收。FIDELITY RETIREMENT MASTER TRUST 富達退休集成信託 CLAIM FORM FOR PAYMENT OF ACCRUED BENEFITS

8、 ON GROUND OF ATTAINING THE RETIREMENT AGE OF 65 OR EARLY RETIREMENT 基於已達到65歲退休年齡或提早退休的理由而申索累算權益的表格FORM MPF(S) - W(R) 表格FRMT/EE/Claim MPF(S)-W(R)-SI/201712Page 1 of 12Trustee and計劃成員的香港身份證副本，以供核對其姓名、出生日期及身份證號碼（如不擬親身出 示計劃成員的香港身份證供核對有關資料）註6；及(2) the original statutory declaration form on early retirement (Form MPF(S)-W(SD1)Note 7 有關提早退休的法定聲明表格（第MPF(S)W(SD1)號表格）註7正本For a scheme member whose HKID card does not contain the month and/or day of birth, evidence showing the scheme members date of birthNo

9、te 8:如計劃成員的香港身份證並未載有出生月份及/或日子，請提供載有該計劃成員出生日期的證明註8：qa copy of the scheme members passport or other travel document showing the month and/or day of birth ; or 載有計劃成員出生月份及/或日子的護照或其他旅遊證件的副本；或 qa copy of the scheme members HKID card with the day and month of the issue date of the HKID card circled or by other means to indicate that the scheme member wishes to use the day and month of the issue date of the HKID card as the day and month of birth; or 計劃成員的香港身份證副本上圈出（或以其他方式顯示）該身份證的簽發日期的月份及日子，以表示計劃成員擬採用其 香港身份證的簽發日期的月份及日子作為其出生月份及日子；或qthe original statutory declaration of the scheme members date of birthNote 7 有關計劃成員出生日期的法定聲明註7正本FRMT/EE/Claim MPF(S)-W(R)-SI/201712Page 4 of 12PART II - DETAILS OF THE CLAIM (CONT.) 第二部 - 申索資料 (續)3. Accrued benefits to be withdrawn from each account specified in Part II (1)Notes 9,10擬從第二部(1)指明的每個帳戶提取的累算權益註 9,10qA lump sumNote 11整筆註11qSpecify withdrawal amountNote 12(HKD) 註明提取金額註12（

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