Postal Review on Old Age Living Allowance Cases
|
|
- Herbert Walters
- 8 years ago
- Views:
Transcription
1 Postal Review on Old Age Living Allowance Cases 14 September 2015 Dear Sir/Madam, The Social Welfare Department SWD regularly conducts postal review on Old Age Living Allowance OALA cases in order to verify whether the recipients continue to be eligible for the allowance. According to SWD s record as at 5 September 2015, you are currently receiving OALA and required to undergo the postal review this year to establish your continued eligibility. Please complete and sign the attached Postal Review Form for Old Age Living Allowance Cases and mail it back to Social Welfare Department, P.O. Box 2200, Kowloon East Post Office, Kowloon within one month from the date of issue of this notification letter by using the return envelope. Our staff may contact you for confirmation of the information provided when necessary. After completing the investigation, if you still meet the income and asset requirements of OALA, SWD will continue to arrange payment of OALA to you. However, if your and / or your spouse s income and / or assets has / have exceeded the prescribed limits, you will no longer be eligible for OALA. SWD will then arrange to stop payment of OALA and notify you separately in writing. If you have any enquiries, please visit SWD website at or call the OALA hotline at Social Welfare Department This is a computer-generated letter and does not require a signature Note: Please complete and return the Postal Review Form for Old Age Living Allowance Cases within the specified period. Otherwise, SWD will not be able to establish your continued eligibility for OALA and will need to consider suspending the OALA payment to you.
2 Notice to Old Age Living Allowance Recipients under the Social Security Allowance Scheme Income and Assets 1. A recipient must be having income and assets not exceeding the prescribed limits as follows: Single person Married couple Total income per month $7,340 $11,830 Case review Total assets value $210,000 $318,000 a Income includes wages from employment; income from handiwork, business, etc. including salaries, wages, monthly commissions or bonuses received, and monthly income from self-employment; retirement benefits/pensions; and net income on rentals collected. Contributions from family members, relatives or friends, and monthly payments received under reverse mortgage schemes are excluded, but any unspent and accumulated amount of savings/cash in hand generated will be treated as assets. b Assets 1 include land and non-owner occupied properties 2 ; cash in hand; bank savings; investments in stocks and shares including bonds, trust fund and accrued retirement benefits 3 ; vehicle for investment e.g. taxi and public light bus and its business licence; and gold bars and gold coins, etc. Owner occupied property, columbarium niche for self-use in future, and the cash value of insurance schemes are excluded. 1 Including those in Hong Kong, Macau, the Mainland or overseas. 2 Only the value of one residential property which is the principal place of residence in Hong Kong is disregarded. Other properties separately or jointly owned by the applicant and/or his/her spouse are regarded as non-owner occupied properties and should be taken into account for assessment of assets. 3 Accrued retirement benefits refer to the retirement benefits currently held in Mandatory Provident Fund MPF Schemes or other retirement schemes. The estimated total amount of such accrued benefits is based on information on the latest benefit statements issued by MPF trustees or other retirement schemes trustees/administrators or information obtained through other relevant documents. 2. SWD conducts data matching periodically/on need basis with other government departments, banks and organizations including the Immigration Department, Treasury, Correctional Services Department, Land Registry, Companies Registry, Hospital Authority and Transport Department, etc. to cross-check the information provided by the recipient. Besides, SWD also conducts reviews on targeted OALA cases. The recipient should cooperate fully with the officers of SWD. Permissible Limit of absence from Hong Kong during receipt of allowance 3. When a recipient has resided in Hong Kong for not less than 60 days in a payment year during receipt of allowance, his/her temporary absences from Hong Kong will not affect the payment of full year allowance. Correspondingly the total number of days of absence in the year cannot exceed 305 days or 306 days in a leap year. Otherwise, the recipient is eligible to receive the allowance only for the periods during which he/she has resided in Hong Kong. Important notes 4. The recipient must provide true, correct and complete information to SWD. A person who knowingly or wilfully provides false statement or withholds any information in order to obtain the allowance by deception commits a criminal offence. He/She is also breaking the law if he/she has the deliberate intention of not reporting changes in information provided which may cause a reduction of the amount of allowance payable or disqualification for the allowance. The recipient may be liable to prosecution. Furthermore, any overpaid allowance must be refunded to SWD
3 Enquiries 5. Enquiries about OALA can be made to the OALA hotline at during office hours. Personal Information Collection Statement Please read this notice before you provide any personal data to the Social Welfare Department Purposes of Collection 1. The personal data supplied by you will be used by SWD to provide appropriate assistance or service from SWD which is relevant to your/the recipient s needs, including but not limited to monitoring and review of services and conducting of research and surveys, and for discharging statutory duties. The provision of personal data to SWD is voluntary. If you do not provide sufficient personal data, we may not be able to process your application/case or provide assistance/service to you/the recipient. Classes of Transferees 2. The personal data you provide will be made available to persons working in SWD on a need-to-know basis. Apart from this, they may only be disclosed to the relevant parties or in the circumstances listed below : a Other parties such as government bureaux/departments, non-governmental organizations and public utility companies if they are involved in the assessment of application from or provision of service/assistance to you/the recipient; b Where such disclosure is authorized or required by law; or c Where you have given consent to such disclosure. Access to Personal Data 3. Except where there is an exemption provided under the Personal Data Privacy Ordinance, you have a right of access to and correction of personal data held on you when the data have not been erased. However, data will usually be erased after fulfilling the purposes of collection. Your right of access under the Ordinance means the right to obtain a copy of your personal data subject to payment of a fee. Applications for access to data should be made either on application form or by a letter. Application forms for access to data are available at offices/centres of SWD. Enquiries, Access to and Correction of Personal Data 4. Please ensure that the data you provide to SWD are accurate. If you have enquiries concerning your application for assistance/service or if there are changes in the data you provide, please contact the office which collected the data from you. 5. Requests for access to personal data collected by SWD and correction of data obtained from a data access request should be addressed to: Post Title : Officer-in-charge Social Security Field Unit Address : Room, Floor, Street, District / - 3 -
4 男 女 * A B C - S * 注 意 : 填 寫 前, 請 先 詳 閱 公 共 福 利 金 計 劃 長 者 生 活 津 貼 受 惠 人 須 知 請 用 黑 色 或 藍 色 原 子 筆, 以 正 楷 填 寫 如 書 寫 錯 檔 誤 案, 請 號 用 碼 旁 簽 署 作 實, 切 勿 使 用 塗 改 液 筆 劃 線 刪 改, 並 在 Casefile Reference : 長 者 津 貼 ABC-S Old Age Living Allowance 郵 遞 覆 檢 表 格 Postal Review Form 第 一 部 份 申 請 人 的 個 人 資 料 Note: Please read carefully the Notice to Old Age Living Allowance Recipients under the Social Security Allowance Scheme and complete all items in this form in 姓 block 名 中 英 letters 文 身 份 證 明 文 件 號 碼 with a blue or black pen. Please cross out any 婚 出 生 日 期 incorrect 姻 狀 況 entries and 已 sign against 同 居 the 請 填 amendment. 寫 第 二 部 份 Do not use correction fluid. Part 1 Personal Particulars of Applicant 現 * 未 婚 / 離 婚 / 分 居 / 喪 偶 Name 通 時 訊 地 in Chinese Identity document number Date of birth *Married/Cohabited Please fill Part 2 如 與 住 址 不 同, 始 須 填 寫 住 流 宅 動 電 話 號 碼 Marital *Never married/divorced/separated/widowed Name in English status 第 二 部 份 申 請 人 配 偶 的 個 人 資 料 Present residential address 姓 名 中 文 英 文 Correspondence address Telephone number 性 別 身 份 證 明 文 件 號 碼 Only if different from residential address Mobile phone number Part 住 出 生 日 期 年 月 日 2 Spouse s personal data 如 址 與 申 請 人 住 址 不 同, 始 須 填 寫 Name in Chinese Name in English Identity document number 第 三 部 份 申 請 人 及 其 配 偶 的 入 息 及 資 產 Male Female 甲 Sex. 每 月 入 息 以 港 幣 計 算 Date of birth Year Month Day Residential address Only 工 資 if different 手 工 業 申 請 人 配 偶 from 或 生 applicant s 意 上 的 入 residential 息 等 address Part 3 Monthly income and assets value of the applicant and spouse 退 A. Income per month in Hong Kong dollars 收 休 租 金 所 得 長 的 俸 淨 收 益 Applicant Spouse 1. Wages from employment, income from handiwork, business, etc. 沒 有 有 沒 有 有 2. * 請 刪 在 去 適 每 月 總 入 息 / 不 當 適 方 用 格 字 內 句 填 上 號 合 計 合 計 Retirement benefits/pensions 3. Net income on rentals collected Monthly total income Tick as appropriate. Delete whichever is inappropriate. 性 別 Sex - 4 -
5 乙 資 產 包 括 在 香 港 澳 門 內 地 或 海 外 所 擁 的 資 產 以 港 幣 計 算 土 現 地 金 非 自 住 物 業 申 請 人 配 偶. B. Assets including those in Hong Kong, Macau, the Mainland or overseas in Hong Kong dollars 及 銀 股 累 行 票 算 儲 退 蓄 股 休 份 權 的 益 投 資 包 括 債 券 基 金 Applicant Spouse 1. / Land/non-owner occupied property 2. Cash in hand 3. Bank savings 4. 營 金 商 業 條 牌 及 車 照 金 輛 幣 例 等 如 的 士 及 公 共 小 其 Investments in stocks, shares 沒 有 No 有 Yes $ 沒 有 No 有 Yes $ including bonds, trust fund and accrued retirement benefits 5. Gold bars and gold coins, etc. 6. 第 四 部 即 份 下 方 簽 聲 署 人 明 總 及 現 值 保 聲 證 明 據 本 所 知, 本 表 以 上 合 計 合 計 Vehicle for investment e.g. taxi and 所 列 各 項 資 料 是 正 確 No 無 訛 Yes $ No Yes $ public light bus and its business licence Total value / 如 本 以 上 表 內 所 列 的 資 料 有 任 何 改 變, 或 * 本 / 申 請 人 離 開 香 港 被 拘 禁, 本 人 將 從 速 向 社 會 福 利 署 申 報 資 和 人 料 配 同 及 偶 意 記 的 社 錄 個 會 提 人 福 供 資 利 予 料 署 社 及 就 會 記 * 錄 本 人 署 例 / 申 如 請 * 人 本 領 人 取 / 申 公 請 共 人 福 的 利 出 金 入 事 境 而 電 進 腦 行 資 有 料 關 的 用 調 來 查 進, 行 包 資 括 料 向 核 入 對 境 程 事 序 務 處 本 人 各 亦 政 同 府 意 部 該 門 等 政 銀 府 行 部 及 門 其 他 銀 團 行 體 及 其 人 他 士 團 索 體 取 * 本 人 士 / 申 將 請 所 人 需 Part 4 Declaration and undertaking I, the undersigned, DECLARE that to the best of my knowledge and belief, the information in the above items is true. I undertake to report immediately to the Social Welfare Department any changes in the particulars contained herein. I further undertake to report immediately to the Social Welfare Department *my/the applicant s departure from Hong Kong or imprisonment. 已 閱 讀 夾 附 的 公 共 福 利 金 計 劃 長 者 生 活 津 貼 受 惠 人 須 知, 包 括 收 集 個 人 資 料 聲 明 書, 並 明 白 其 內 容 I consent to any investigations into the circumstances relating to *my/the applicant s receipt of Social Security Allowance being carried out by the Social Welfare Department, including but not limited to asking the Immigration Department, other government departments, banks and other parties to match *my/the applicant s personal 明 同 白 意 data 社 會 relating 福 利 署 有 to 從 權 **my/the 本 從 人 * 本 / 申 人 applicant s 請 / 人 申 請 / 代 人 理 每 人 月 receipt 所 可 指 得 定 的 of 領 津 Social 取 貼 公 金 共 中 Security 福 扣 利 除 金 經 Allowance 的 社 銀 會 行 福 帳 利 戶 署 with 取 核 回 實 *my/the 任 的 何 多 領 applicant s 款 項 本 personal 人 亦 同 意 data 所 指 held 定 領 by 取 such 公 共 other 福 利 金 departments 的 銀 行, 從 or * 本 such 人 other parties such as travel records held on the computer and those of *my/the applicant s spouse. I also consent to such government departments, banks and parties providing the requested data and records to the Social Welfare Department. I have read the enclosed Notice to Old Age Living Allowance Recipients, including the Personal Information Collection Statement therein and understand its 本 / 申 請 人 / 代 理 上 述 的 銀 行 帳 戶, 扣 除 經 社 會 福 利 署 核 實 的 多 領 款 項 content. I understand that the Social Welfare Department has the right to deduct from *my/the applicant s monthly entitlements any amount certified by the Social Welfare 以 人 Department 上 明 聲 白 明 如, as 本 人 蓄 overpayment. 已 意 詳 或 細 存 閱 心 讀 提, 供 本 不 人 正 亦 確 完 資 全 料 明 或 白 隱 瞞 任 何 事 項, 或 錯 誤 引 導 社 會 福 利 署, 以 圖 獲 得 現 金 援 助, 將 有 被 檢 控 的 可 能 I agree to the Social Welfare Department to recover any overpayment received for *me/the applicant directly from *my/the applicant s/the agent s bank designated for receiving Social Security Allowance payment. I also agree to that designated bank for receiving Social Security Allowance payment to debit *my/the applicant s/the agent s bank account from time to time with any amount certified by the Social Welfare Department as overpayment. I understand that if I knowingly or wilfully make any false statement or withhold any information, or otherwise mislead the Social Welfare Department for the purpose of obtaining payments, it will render me liable to prosecution. 日 見 期 證 人 姓 名 收 表 格 日 期 蓋 印 The above statement has been read by me and well understood by me. * 請 刪 在 去 適 不 當 適 方 用 格 字 內 句 填 上 號 witness 此 欄 供 本 署 填 寫 Official chop for Name of witness receipt of this form Date Tick as appropriate. Delete whichever is inappropriate. Applicable if there is a witness. For office use 申 見 請 證 人 人 * 簽 * 簽 名 名 / 指 / 指 模 模 *Signature/Thumbprint of applicant 如 有 見 證 人 則 須 簽 署 及 填 寫 *Signature/Thumbprint of 巴 及 - 5 -
HSBC CREDIT CARD APPLICATION FORM
To: The Hongkong and Shanghai Banking Corporation Limited, Macau Branch Branch Please return the completed application form together with support documents to any HSBC branch Date day / month / year HSBC
More informationNOTES TO TRANSFER BENEFITS BY SCHEME MEMBER (for self-employed person, personal account holder or employee ceasing employment)
NOTES TO TRANSFER BENEFITS BY SCHEME MEMBER (for self-employed person, personal account holder or employee ceasing employment) Please read the following important information before you complete Form MPF(S)-P(M).
More information2015/16 Non-means-tested Loan Scheme for Full-time Tertiary Students (NLSFT) Points to Note for Submission of Late Application
(No submission of this page is required. This page is for information only.) 2015/16 Non-means-tested Loan Scheme for Full-time Tertiary Students (NLSFT) Points to Note for Submission of Late Application
More informationAPPLICATION FORM. / / / PENSION ANNUITY. Once you ve completed this form, please return it to: Legal & General Annuities PO Box 809 Cardiff CF24 0YL
PENSION ANNUITY APPLICATION FORM. Once you ve completed this form, please return it to: Legal & General Annuities PO Box 809 Cardiff CF24 0YL We will already have sent you a quote(s), illustrating the
More information(Chapter No. not allocated yet) SOCIAL SECURITY ORDINANCE
(Chapter No. not allocated yet) SOCIAL SECURITY ORDINANCE Non-authoritative Consolidated Text This is not an authoritative revised edition for the purposes of the Revised Edition of the Laws Ordinance;
More informationGuidance Notes to Applicant for Opening Corporate Investor Account in CCASS
香 港 中 央 結 算 有 限 公 司 ( 香 港 交 易 及 結 算 所 有 限 公 司 全 資 附 屬 公 司 ) Hong Kong Securities Clearing Company Limited (A wholly-owned subsidiary of Hong Kong Exchanges and Clearing Limited) Guidance Notes to Applicant
More informationPersonal Account Opening Form
Note: 1. Please complete in Block Letters and tick where applicable. 2. Information with shading must be completed. Date day / month / year Requested Account Type Information Account Type and Currency
More informationOPERATING ENGINEERS TRUST FUNDS
OPERATING ENGINEERS TRUST FUNDS 1640 South Loop Road Alameda, CA 94502 P.O. Box 23190 Oakland, CA 94623-0190 Telephone (510) 433-4422 or (510) 271-0222 or Claims Department (800) 251-5013 Pension Department
More informationTHE LAND REGISTRY E-ALERT SERVICE - APPLICATION FOR CHANGE OF PARTICULARS
THE LAND REGISTRY E-ALERT SERVICE - APPLICATION FOR CHANGE OF PARTICULARS Part A Particulars of Subscriber s Account Account No. - - EAL Account Name Verification Code [Note (i)] *HKID Card No./Company
More informationFORM A. Application for Direct Payment of Medical Expenses on Drugs Provided by the Hospital Authority. in accordance with CSB Circular No.
Restricted (Staff) FORM A Application for Direct Payment of Medical Expenses on Drugs Provided by the Hospital Authority in accordance with CSB Circular No. 2/2013 (Applicants should read CSB Circular
More informationMedical Card / GP Visit Card Application Form - MC1
This is not an on-line form. Please print and complete manually. Medical Card / GP Visit Card Application Form - MC1 Date Received Please read the back page help sheet carefully before you complete the
More informationBelize Retired Persons (Incentives) Program
Belize Retired Persons (Incentives) Program Belize Tourism Board About the Program The Retirement Program in Belize was created especially for those people who wish to live in Belize and can prove a permanent
More informationHONG KONG POLICE FORCE
PERSONAL DATA 個 人 資 料 Page 1 Current Licence No. HONG KONG POLICE FORCE Firearms and Ammunition Ordinance (Chapter 238) Application for Amendment / Cancellation of Licence Before completing this form,
More informationEmployer Insurance Application
for Property Focused Employer Sponsored Super Before you sign this application form, the Trustee or your financial adviser is obliged to give you the Property Focused Super Product Disclosure Statement
More informationAYERS Alliance Business Account Application Form
AYERS Alliance Business Account Application Form AYERS Alliance Business Account Application and Mandate APPLICANT DETAILS Complete the form using a BLACK PEN and print in clear CAPITAL LETTERS Legal Name
More informationDRUG DEPENDENT PERSONS TREATMENT AND REHABILITATION CENTRES (LICENSING) ORDINANCE (CAP. 566)
DRUG DEPENDENT PERSONS TREATMENT AND REHABILITATION CENTRES (LICENSING) ORDINANCE (CAP. 566) APPLICATION / RENEWAL * FOR A LICENCE / CERTIFICATE OF EXEMPTION * Remark : (i) Before filling in the form,
More informationHONG KONG HOUSING AUTHORITY
HONG KONG HOUSING AUTHORITY HOME OWNERSHIP SCHEME AND PRIVATE SECTOR PARTICIPATION SCHEME GUIDANCE NOTES ON APPLICATION FOR REFINANCING HD1309-E (Rev. 06/08) This pamphlet outlines the policy and procedures
More informationWHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME
WHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME Issued 1 November 2014 Please use this form to transfer your whole superannuation balance to a KiwiSaver scheme. Transferring only part of your superannuation
More informationPROBATE AND ADMINISTRATION ORDINANCE (CHAPTER 10)
Home Affairs Department Estate Beneficiaries Support Unit 3rd Floor, Southorn Centre, 130 Hennessy Road, Wan Chai, Hong Kong. Tel.: 2835 1535 PROBATE AND ADMINISTRATION ORDINANCE (CHAPTER 10) Form HAEU5
More informationAPPLICATION FOR RETIREMENT (OLD AGE) AND INVALIDITY BENEFITS UNDER THE NATIONAL INSURANCE ACT OF 1965 JAMAICA
APPLICATION FOR RETIREMENT (OLD AGE) AND INVALIDITY BENEFITS UNDER THE NATIONAL INSURANCE ACT OF 1965 JAMAICA INSTRUCTIONS: I. This form is to be completed in BLOCK CAPITALS using black or blue ink pen;
More informationHealth Benefits for Workers with Disabilities Application
Illinois Department of Public Aid Health Benefits for Workers with Disabilities Application Note: This is NOT an application for cash assistance, food stamps or enrollment in the Medicaid spenddown program.
More informationFinancial Undertaking for a Student
OFFICE USE ONL Client no.: Date received: / / Application no.: INZ 1014 Financial Undertaking for a Student Supporting information for an application for a student visa Who can provide a financial undertaking
More informationMedical Card Application Form - Over 70 Years of Age
Medical Card Application Form - Over 70 Years of Age Form MC1a Please read the Information Notes at the end of this Application Form OFFICE USE ONLY Date Received: Card No... Part 1 - Applicants Details
More informationCLAIM FOR WORKERS COMPENSATION
CLAIM FOR WORKERS COMPENSATION Seafarers Rehabilitation and Compensation Act 1992 Information about claiming workers compensation In this document, all references to the employer mean the employer against
More informationOctopus Automatic Add Value Service Application Form. Fax No.: 2834 8903
Fax No.: 2834 8903 or Mail: DBS Bank (Hong Kong) Limited T&O-Card Servicing Level 13, Millennium City 6, 392 Kwun Tong Road, Kwun Tong, Kowloon HongKong/CPF/CSV/0045(05/12) All fields are mandatory. Applicant
More informationApplication for Bond Loan and Rental Grant assistance
Office use only (application number) Bond Loan Rental Grant Application for Bond Loan and Rental Grant assistance The Department of Housing and Public Works provides Bond Loans and Rental Grants to people
More informationQuestionnaire Cornwell-Type Claims
Sensitive: Personal once completed Questionnaire Cornwell-Type Claims Please complete all sections of this form and enter N/A in any section that is not applicable to indicate that the question has been
More informationHow To Apply For A Medicaid Or Medicaid Savings Plan In Garyand
Georgia Application for Medicaid & Medicare Savings for Qualified Beneficiaries (QMB - payment of premiums, coinsurance, and deductibles; SLMB - payment of Part B premium; and QI-1 - payment of Part B
More informationCommercial Mortgage Application Form
Aldermore 1st Floor, Block B Western House Lynch Wood PETERBOROUGH PE2 6FZ Commercial Mortgage Application Form t 01733 404500 f 0800 0664429 e info@aldermore.co.uk w aldermore.co.uk Intermediary details
More informationHome Loan Application
If you do not have the latest version of Adobe Acrobat Reader installed on your PC, please click this link to download Acrobat Reader for free. Application details Name in which account is to be opened
More informationTransfer application form
For customers Guaranteed Pension Annuity (tax-free cash) Transfer application form Illustration number Agent number / Agent phone number Agent fax number Agent email address Page 1 of 12 Application checklist
More informationX NSW/ACT X NT X QLD X SA X TAS X VIC X WA
1. Please complete this form USING BLACK INK and write within the boxes in CAPITAL LETTERS. Mark appropriate answer boxes with a CROSS. Start at the left of each answer space and leave a gap between words.
More informationInland Revenue Department. Tax Return-Individuals (BIR60) (4/2014)
Inland Revenue Department Guide to Tax Return-Individuals (BIR60) (4/2014) This Guide explains how to complete the Tax Return - Individuals (BIR60). Most of your questions will be answered here. Tables
More informationChange of address and/or passport details
Change of address and/or details Form 929 ImmiAccount You can now update your address and details online via your ImmiAccount available on the Department of Immigration and Border Protection (the ) website
More information(1) Introduction to Mandatory Provident Fund 2-3. (2) Enrolment 4. (3) Contribution Arrangement 4-6. (4) Voluntary Contributions 6
Contents Pages (1) Introduction to Mandatory Provident Fund 2-3 (2) Enrolment 4 (3) Contribution Arrangement 4-6 (4) Voluntary Contributions 6 (5) Special Voluntary Contribution Account 6-7 (6) Change
More informationVILLAGE REHAB PROGRAM
I N T E R I O R R E G I O N A L H O U S I N G A U T H O R I T Y 8 2 8 2 7 T H A v e n u e F a i r b a n k s, A l a s k a 9 9 7 0 1 P h o n e : ( 9 0 7 ) 1-8 0 0-4 7 8-4 7 4 2 F a x : ( 9 0 7 ) 4 5 2-8
More informationHow To Set Up A Trading Account In Hong Kong Korea
Account Code: W h o l l y O w n e d S u b s i d i a r y o f A g r i c u l t u r a l B a n k o f C h i n a L t d ( E x c h a n g e P a r t i c i p a n t o f T h e S t o c k E x c h a n g e o f H o n g K
More informationRESIDENTIAL REHABILITATION PROGRAM
City of North Lauderdale COMMUNITY DEVELOPMENT DEPARTMENT 701 S.W. 71 st Avenue North Lauderdale, Florida 33068 Telephone: (954) 724-7065 Fax: (954) 720-2064 RESIDENTIAL REHABILITATION PROGRAM If you are
More informationNew Zealand Superannuation Application Spouse/Partner
New Zealand Superannuation Application Spouse/Partner If you need help with this form call us on % 0800 552 002. Please read this before you start Being included in your spouse/ partner s New Zealand Superannuation
More informationApplication for a Company Licence
Private Security Personnel Licensing Authority For more information visit www.pspla.govt.nz Application for a Company Licence Under the Private Security Personnel and Private Investigators Act 2010 1 What
More informationApplication for a Permit under S4(17) of Summary Offences Ordinance, Cap.228 for Non-Charitable Purposes
Application for a Permit under S4(17) of Summary Offences Ordinance, Cap.228 for Non-Charitable Purposes This application should reach Division III of Home Affairs Department at 30/F, Southorn Centre,
More informationPolicy Conversion Application Form
Policy Conversion Application Form Proposal No. (For office use only) This form is applicable only to an application for conversion pursuant to the following policy provisions: 1. Convertible Option; 2.
More informationNotice of Accident Claim Form
Insurer s Claim Reference Number Queensland Compulsory Third Party Insurance (CTP) Notice of Accident Claim Form (Non-Fatal Injury) for accidents occurring on and after 1st October 2000 Motor Accident
More informationProper Keeping of Wage and Employment Records
Proper Keeping of Wage and Employment Records Foreword This booklet sets out the major provisions of the Employment Ordinance on wage and employment record keeping, and provides sample and prescribed forms
More informationTHE LAND REGISTRY APPLICATION FOR SUBSCRIPTION TO THE E-ALERT SERVICE
THE LAND REGISTRY APPLICATION FOR SUBSCRIPTION TO THE E-ALERT SERVICE Part A Subscriber s Particulars Subscriber s Name (English) : [Note (i)] (Chinese) : *HKID Card No./Company Registration No./ Other
More informationApplication for a Certificate of Approval
Private Security Personnel Licensing Authority For more information visit www.pspla.govt.nz Application for a Certificate of Approval Under the Private Security Personnel and Private Investigators Act
More informationOther You must complete a W-8BEN form. Please call the phone number above to obtain a form.
Joint - Custodial - Trust - Will be presumed to be joint tenants with rights of survivorship unless restricted by applicable state law or otherwise indicated. Aminor is the beneficial owner of the account
More informationIf this is an application for a Health Professional listed in Part A or Part B of Schedule 2 in the Principal Regulations please tick this box
CSEP002/15 Critical Skills Employment Permit Application This form should be used by either the Person who has made the offer of employment or the Foreign National, the subject of that offer of employment,
More informationData Classification R Supplementary Welfare Allowance Rent Supplement. You need a Personal Public Service Number (PPS No.) before you apply.
Application form for You need a Personal Public Service Number (PPS.) before you apply. How to complete this application form. Please tear off this page and use as a guide to filling in this form. Please
More informationMACHINISTS LODGE 692 HEALTH AND BENEFIT PLAN
MACHINISTS LODGE 692 HEALTH AND BENEFIT PLAN REVISED CARD CHECK HERE h APPLICATION FOR ENROLMENT AND BENEFICIARY DESIGNATION Please complete in ink and print clearly. This is a two-sided form please see
More informationThis application will be processed under the terms of the Agreement between the New Zealand Government and the Government of Malta.
Application for New Zealand Superannuation under a Social Security Agreement Malta This application will be processed under the terms of the Agreement between the New Zealand Government and the Government
More informationJoin GMHBA Transfer from an existing GMHBA membership Change my GMHBA cover
Application form September 2012 1. I wish to (please tick) Join GMHBA Transfer from an existing GMHBA membership Change my GMHBA cover GMHBA member number (existing members only) Cover or change of cover
More informationAdvance Retirement Suite Super Early Release Financial Hardship Application
Advance Retirement Suite Super Early Release Financial Hardship Application Trustee: BT Funds Management Ltd (BTFM) ABN 63 002 916 458 AFSL 233724 GUIDE TO COMPLETING THIS FORM > > Use this form if you
More informationClaim for Special Child Care Benefit and/or increased weekly limit of hours
Claim for Special Child Care Benefit and/or increased weekly limit of hours When to use this form Special Child Care Benefit (rate) for hardship, and/or Increased weekly limit of hours due to exceptional
More informationInsurance Variation Form
Insurance Variation Form SEND YOUR COMPLETED FORM TO: Australian Ethical Super, Locked Bag 5125, Parramatta NSW 2124. Please use BLOCK LETTERS and BLACK ink. Important notes Please use this form if you
More informationRetirement Lump Sum application information (Issued under sections 27, 149, 150, 151 and 213 of the Veterans Support Act 2014)
Retirement Lump Sum application information (Issued under sections 27, 149, 150, 151 and 213 of the Act 2014) Please read before you complete this form This application form is for veterans reaching the
More informationGENERAL INSTRUCTIONS FOR COMPLETING YOUR RETURN
GENERAL INSTRUCTIONS FOR COMPLETING YOUR RETURN PITTSBURGH CITY & SCHOOL DISTRICT The City of Pittsburgh Earned Income Tax is levied at the rate of 1% under ACT 511. The Pittsburgh School District Earned
More informationNotes for Child Care Benefit for registered care
tes for Child Care Benefit for registered care Purpose of these notes For more information These notes provide information for people using registered child care who want to claim Child Care Benefit. With
More informationHOW TO APPLY FOR REGISTRATION AS A SAFETY OFFICER Under the Factories and Industrial Undertakings (Safety Officers and Safety Supervisors) Regulations
HOW TO APPLY FOR REGISTRATION AS A SAFETY OFFICER Under the Factories and Industrial Undertakings (Safety Officers and Safety Supervisors) Regulations Application 1. Application for registration as a safety
More informationRenewal of registration Building surveying contractor (individual) Form 63
Government of Western Australia Department of Commerce Renewal of registration Building surveying contractor (individual) Form 63 Use of this form This form is to be used by building surveyors who are
More informationDisaster Recovery Allowance Tropical Cyclone Marcia (Qld) February 2015
Disaster Recovery Allowance Tropical Cyclone Marcia (Qld) February 2015 1 Do you need an interpreter when dealing with us? 7 Do any of the following apply to you? This includes an interpreter for people
More informationPersonal Instalment Loan - Express Loan Application Form
Page 1 of 5 For Bank Use Only Br CA 10EP011 PR ECA001 Applicant Information A/C Off code ears of Residence Home Tel. No. obile Phone & Pager No. are not accepted E I RE To: DBS Bank Hong Kong Limited the
More informationLocal Government Employees Health Plan Application March 2014
Local Government Employees Health Plan Application March 2014 1. I wish to (please tick) Join GMHBA Transfer from an existing GMHBA membership Change my cover GMHBA member number (existing members only)
More informationDIRECT AIRSIDE TRANSIT (VAF6 DEC
DIRECT AIRSIDE TRANSIT (VAF6 DEC 2008) This form is for use outside the UK only. This form is provided free of charge. READ THIS FIRST This form must be completed in English. You may use blue or black
More informationApplication Form Pure Lump Sum Plan
Application Form Pure Lump Sum Plan This form is an application for a lifetime mortgage with Pure Retirement Limited. To avoid delays in processing the application, it is important that the form is completed
More informationMedical Card and GP Visit Card Application Form - People Aged 70 Years or Older MC1(a)
Medical Card and GP Visit Card Application Form - People Aged 70 Years or Older MC1(a) Who should use this form? People 70 years of age or older and their spouse or partner should use this form when applying
More informationFOR ASSISTANCE PLEASE CALL 703-222-8234 TTY 703-222-7594
2014 Desiree M. Baltimore, Manager, Tax Relief Section Department of Tax Administration 703-222-8234 taxrelief@fairfaxcounty.gov TTY: 703-222-7594 APPLICATION FOR TAX RELIEF COUNTY OF FAIRFAX DEPARTMENT
More informationAs an aged care worker, this incentive is for you to upgrade your qualifications and build your career in aged care.
Aged Care Education and Training Incentive Programme COMPLETION PAYMENT This application form is to be completed by applicants who have completed studies and have already received a commencement payment
More informationREQUEST TO AMEND THE RECORD OF LANDING (IMM 1000), CONFIRMATION OF PERMANENT RESIDENCE (IMM 5292 or IMM 5688) OR VALID TEMPORARY RESIDENT DOCUMENTS
PROTECTED WHEN COMPLETED - B REQUEST TO AMEND THE RECORD OF LANDING (IMM 1000), CONFIRMATION OF PERMANENT RESIDENCE (IMM 5292 or IMM 5688) OR VALID TEMPORARY RESIDENT DOCUMENTS PAGE 1 OF 3 PART A - PERSONAL
More informationImportant Information about Procedures for Opening a New Account
Account Application for a Minor Trust Account Use this form to open a new Plan Account by a Custodian under UGMA/UTMA or a Trustee under a Minor Trust Agreement Questions? Call toll-free 1-877-338-4646
More informationDear Resident, Sincerely, Neighborhood Services Staff. Rehabilitation Program. Purchase/Workforce Program. Completed Application Form
City of Delray Beach Neighborhood Services Division Dear Resident, Thank you for your interest in the City of Delray Beach Neighborhood Services Programs. We are required to document your eligibility for
More informationHSBC UNIONPAY DUAL CURRENCY CREDIT CARD APPLICATION FORM
To : The Hongkong and Shanghai Banking Corporation Limited Branch Please return the completed application form together with support documents to any HSBC branch OR Mail to : The Hongkong and Shanghai
More informationTHE UNIVERSITY OF HONG KONG APPLICATION FOR TRANSCRIPT
THE UNIVERSITY OF HONG KONG APPLICATION FOR TRANSCRIPT 253/912 amended Please read the instructions carefully before submitting your application. INSTRUCTIONS TO APPLICANTS A transcript is a student s
More informationGroup Personal Pension
Application Form (For employed or self-employed individuals) Who this form is for When we refer to Standard Life we mean Standard Life Assurance Limited This form is for employees, or self-employed individuals
More informationLIFE INSURANCE POLICY DOCUMENT. Participating Employer (Universities of NZ) (the employer)
LIFE INSURANCE POLICY DOCUMENT For Employees (as Voluntary Insured Members) Participating Employer (Universities of NZ) (the employer) Administered by Marsh (the policy owner) Insured by Sovereign Assurance
More informationA GUIDE TO THE OCCUPATIONAL RETIREMENT SCHEMES ORDINANCE
A GUIDE TO THE OCCUPATIONAL RETIREMENT SCHEMES ORDINANCE Issued by THE REGISTRAR OF OCCUPATIONAL RETIREMENT SCHEMES Level 16, International Commerce Centre, 1 Austin Road West, Kowloon, Hong Kong. ORS/C/5
More informationApplication for a Mortgage Loan
Application for a Mortgage Loan Branch Name OFFICE USE ON LY Please print neatly in block letters using black or blue pen Lender s Name Loan Purpose & Term Buy a House Buy Land Buy a Unit Purchase Price/Amount
More informationESSEX COUNTY REAL ESTATE TAX EXEMPTION TAX RELIEF FOR THE ELDERLY AND DISABLED TAX RELIEF FOR THE YEAR OF: 20
ESSEX COUNTY REAL ESTATE TAX EXEMPTION TAX RELIEF FOR THE ELDERLY AND DISABLED TAX RELIEF FOR THE YEAR OF: 20 Income can not exceed 27,500 Financial worth can not exceed 100,000 Maximum exemption granted
More informationAs an aged care worker, this incentive is for you to upgrade your qualifications and build your career in aged care.
Aged Care Education and Training Incentive Programme COMMENCEMENT PAYMENT This application form is to be completed by eligible aged care workers who have enrolled and commenced studies to enhance their
More informationProfessional Diploma for ACCREDITED ACCOUNTING TECHNICIANS
Professional Diploma for ACCREDITED ACCOUNTING TECHNICIANS The University of Hong Kong School of Professional and Continuing Education College of Business and Finance http://hkuspace.hku.hk/cbf/ Sept 2010
More informationSpecial Needs Grant International Custody Dispute Payment
Special Needs Grant International Custody Dispute Payment CLIENT NUMBER If you need help with this form call us on % 0800 559 009. Who can get this payment If you need help filling in this form, please
More informationLOAN APPLICATION AND AGREEMENT FORM (Revised, May 17, 2014)
LOAN APPLICATION AND AGREEMENT FORM (Revised, May 17, 2014) CHECK LIST: COLLATERAL CHECK LIST Original duly filled Loan form Loanee signature Pg 3 & 5 Original Log book/title Copy of ID attached Witness
More informationSippchoice Bespoke SIPP
Sippchoice Bespoke SIPP Application Form (from 1 October 2015) Please indicate the unique reference number shown on the Key Features Illustration that you received with this application. Failure to complete
More informationWestpac Business Debit MasterCard Application
Westpac Business Debit MasterCard Application Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714 In order to apply for a Westpac Business Debit MasterCard, the following
More informationAPPLICATION FORM - PERSONAL INJURY (Do not use for fatal injuries)
The Compensation Agency Royston House 34 Upper Queen Street Belfast BT1 6FD www.compensationni.gov.uk THE COMPENSATION Agency Reference number For official use only T1 Criminal Injuries Compensation Scheme
More informationCLAIM FOR TRANSPORT SUBSIDY FOR ANIMAL WELFARE
CLAIM FOR TRANSPORT SUBSIDY FOR ANIMAL WELFARE NOTE: Submit all claim forms with original invoices, receipts and other documents attached. All invoices will be copied and returned to the claimant. Initial
More informationCLAIM FORM - WORK INJURY COMPENSATION INSURANCE. Section 1 - Particulars of Insured. Section 2 Particluars of Injured Worker
CLAIM FORM - WORK INJURY COMPENSATION INSURANCE Agency: Policy No.: Please note: 1. The acceptance of this form is NOT an admission of liability on the part of the Company. 2. All original bills, certificates,
More informationHousehold Composition Income & Assets Review
GREATER SUDBURY SOCIÉTÉ DE LOGEMENT HOUSING CORPORATION DU GRAND SUDBURY Household Composition Income & Assets Review To continue to be eligible for assisted rental housing, you are required by the terms
More informationHomeowner Rehabilitation Program Application
This program is designed to remove potentially dangerous health and/or safety hazards from homes owned by very low income persons as their primary residence. The repairs could also include adding accessibility
More informationLicence Application Form COMPANY
Licence Application Form COMPANY Completing this form Use BLACK pen only Print clearly in BLOCK LETTERS DO T use correction fluid any amendments should be crossed out and initialled 1. COMPANY DETAILS
More informationGuide to Lodging Application Form First Home Owner Grant Scheme
Guide to Lodging Application Form First Home Owner Grant Scheme Guide to Lodging Application Form First Home Owner Grant Scheme NOTE This guide is for your assistance and should not be lodged with your
More informationApplication to register a change of name (adult 18 years or over)
Government of Western Australia Department of the Attorney General Registry of Births, Deaths & Marriages BDM400 Application to register a change of name (adult 18 years or over) Eligibility You must be
More informationRULES FOR FILING A CLAIM AND APPEAL RIGHTS
DIVISION OF TEMPORARY DISABILITY INSURANCE APPLICATION FOR FAMILY LEAVE INSURANCE BENEFITS (FL-1) DETACH THIS PAGE AND KEEP FOR YOUR RECORDS RULES FOR FILING A CLAIM AND APPEAL RIGHTS 1. It is your responsibility
More informationIIT and Social Insurance for Foreigners Employed in China.
IIT and Social Insurance for Foreigners Employed in China. www.lehmanbrown.com Individual Income Tax (IIT) General IIT Principles For individuals to pay tax in China (PRC Tax Resident), they need to be
More informationAPPLICATION FOR. License Fee Only. Non- NZTA
C4:08-15 NEW ZEALAND THOROUGHBRED RACING INC PO Box 38386, WMC Telephone: (04) 576 6240 Facsimile: (04) 568 8866 Web: www.nzracing.co.nz Email: licensing@nzracing.co.nz APPLICATION FOR Non- NZTA License
More informationVoluntary Disability Benefits
Voluntary Disability Benefits Enclosed you will find a disability packet that will provide information to assist you in filing for disability benefits through The Claremont Colleges Voluntary Disability
More informationInstructions and form for individuals living outside Australia. Tax file number application or enquiry for individuals living outside Australia
Instructions and form for individuals living outside Australia Tax file number application or enquiry for individuals living outside Australia NAT 2628 04.2014 INTRODUCTION YOUR TAX FILE NUMBER (TFN) AND
More informationNON-REGULATED BRIDGING LOAN
NON-REGULATED BRIDGING LOAN PERSONAL APPLICATION FORM Borrowers Name: Address of property to be used as security: Please note: Mint Bridging Limited is not authorised and not regulated by the Financial
More informationCORPORATE VOLUNTARY DIRECT DEBIT APPLICATION
CORPORATE VOLUNTARY DIRECT DEBIT APPLICATION 1. Please complete this form USING BLACK INK and write within the boxes in CAPITAL LETTERS. Mark appropriate answer boxes with a CROSS. Start at the left of
More informationCommunity Underwriting Personal Accident Claim Form
Community Underwriting Personal Accident Claim Form About Community Underwriting Community Underwriting Agency Pty Ltd (Community Underwriting) acts under a binding authority as Agent for Berkley Insurance
More information