From 1 January 2020, HSBC Mandatory Provident Fund – SuperTrust Plus became a reporting financial institution under

*IN61*
the Inland Revenue Ordinance (Cap. 112) (‘the Ordinance’). To comply with the Ordinance, please provide and confirm to
us your tax residency information through the relevant new application form embedded with the Tax Residency Self-
Certification for any MPF scheme/account enrolled on or after 1 January 2020. Otherwise, the MPF scheme/account
enrollment process would be adversely affected and we would be unable to complete the process for you. 2020 1 1
112 2020 1
1

To : HSBC Provident Fund Trustee (Hong Kong) Limited

IN61
c/o The Hongkong and Shanghai Banking Corporation Limited
PO Box 73770 Kowloon Central Post Office 73770
or
Place into the MPF drop-in box at designated HSBC branches

HSBC MPF Employer Hotline 2583 8033

HSBC MPF Member Hotline 3128 0128

HSBC MANDATORY PROVIDENT FUND – SUPERTRUST PLUS

EMPLOYEE APPLICATION FORM

Note
1. Please complete in CAPITAL and BLOCK LETTERS and tick  the appropriate box(es). 
2. This application is issued in conjunction with the MPF Scheme Brochure.
3. To change your identification number, please provide written notice together with a copy of supporting document to us and inform your employer immediately for
updating such record on MPF contribution issue.

4. Please note that if you wish to register for HSBC Online Banking and Mobile Banking (these services are not available for passport holders with passport numbers
containing more than 12 characters (including English letters and/or digits)), you should provide your residential address in English, mobile phone number, and
email address. 12

5. The information (including any blank field) that you provided in Section A of this form will automatically apply to ALL your accounts maintained with HSBC MPF
under the HKID/Passport number stated in Section A3 below. If you wish to change your personal details for a specific account, please complete the 'Personal
Details Change Form' (IN91). If you wish to change your personal details for non-HSBC MPF account (e.g. HSBC Banking Service), please submit a relevant change
form or you can change your personal details for your HSBC accounts via the HSBC Personal Internet Banking at . A
A 3
(IN91)

6. The Default Investment Strategy (“DIS”) is a ready-made investment arrangement mainly designed for those members who are not interested or do not wish to make
an investment choice, and is also available as an investment choice itself, for members who find it suitable for their own circumstances. For those members who
do not make an investment choice, their future contributions and accrued benefits transferred from another Registered Scheme will be invested in accordance with
the DIS. The DIS aims to balance the long term effects of risk and return through investing in two Constituent Funds, namely the Core Accumulation Fund and the
Age 65 Plus Fund, according to the pre-set allocation percentages at different ages. The DIS will manage investment risk exposure by automatically reducing the
exposure to higher risk assets and correspondingly increasing the exposure to lower risk assets as the member gets older. For further details of the DIS, please
refer to the relevant ‘MPF Scheme Brochure’.

65

7. ‘Registered Scheme’ means a retirement benefits scheme registered under section 21 or 21A of the ‘MPF Ordinance’. 21
21A
8. If you have already registered as a HSBC Personal Internet Banking user, you can select to receive MPF member benefit statement electronically. To know more
about registration of and access to the electronic MPF member benefit statement, please visit .

PART I – EMPLOYEE SECTION – (to be completed by employee )

A. DETAILS OF APPLICANT
1. Full name in English* * (same as that shown on your HKID card/Passport 2. Chinese name (if any)

Surname Given name

3. Identification number (please provide a copy )

 HKID card no. ( )

 Passport no. (ONLY applicable for person without HKID card, please provide the place of issue.) (
):
Place of issue :
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A. DETAILS OF APPLICANT (CONT‘D)
4. Date of birth* * 5. Sex
Year Month Day  Male  Female

If your HKID card only contains the year and you have no other form of identity to prove the exact date of birth (e.g. birth certificate, passport), you should use 31
December as the day and month. Likewise, if your HKID card contains the year and month but not the day, you should use the last day of the month shown. If you
leave the day and/or month blank, your date of birth will be regarded as the last day of that month or 31 December.
12 31
12 31

6. Nationality (Country/Region) 1
Multiple nationality (Country/Region)  Yes  No
Nationality (Country/Region) 2 (if any )
Nationality (Country/Region) 3 (if any )

7. Residential address (The main address the majority of the time is spent or resided) (in English)

• PO Box address is not accepted

• Correspondence will be sent to this address

Effective date for residential address

Year Month

Room/Flat Floor Block Name of building

Name of estate Number and name of street/road

 HK  KLN  NT  Others
District/Postal code City* * Country/Region*
*

Country/Region code Area code Phone no.

8. Residential telephone no.1 1

9. Mobile phone no.1,2 1,2

10. Email address2 2

If you have already registered as a HSBC Personal Internet Banking user, you can also register for the MPF e-Statement and e-Advice service by
completing Section A11. A 11
Are you an existing HSBC Personal Internet Banking user ?

 Yes (please complete Section A11 A 11 )

 No (you may skip Section A11. If you wish to register for HSBC Personal Internet Banking to receive the MPF e-Statement and e-Advice, please
visit our website hsbc.com.hk or call our hotline for details. A 11
hsbc.com.hk )

11. MPF e-Statement and e-Advice service (If you have already registered this service, you may skip this
section. )
Notes
This electronic service is available to those customers who have provided a valid email address with HSBC MPF AND have already registered as a HSBC Personal Internet
Banking user.
The email address indicated above will be used as your designated email address to receive email notifications, e.g. eReminder (if any) for MPF e-Statement and e-Advice
service, and MPF related email communications of all your MPF account(s) (if applicable) going forward.

Scan the QR code or visit our website hsbc.com.hk to view the electronic version
of ‘Terms and Conditions’ and ‘Note’ for MPF e-Statement and e-Advice
service. hsbc.com.hk

Terms and Conditions Note

Do you wish to register for the MPF e-Statement and e-Advice service? e-Statement and e-Advice service e-Statement and e-Advice service
?

 Yes  No
(By enrolling for the MPF e-Statement and e-Advice service, I agree to and
confirm all the ‘Terms and Conditions’ and ‘Note’ for the MPF e-Statement and
e-Advice service.
)

12. Preferred language for correspondence  English  Chinese

If preferred language is not selected, English will be used for member correspondence.

* The information is required to be reported by the reporting financial institution to the Inland Revenue Department.
1
If you are providing overseas contact details outside Hong Kong SAR, please also include the correct Country/Region Code and Area Code. However, for overseas mobile numbers, usually there is no need
IN61 v40/0624 (0624) H

to add an Area Code and you may check with your telecommunications service provider for details.

2
Please provide your personal mobile phone no. and email address which are exclusively for your own use to ensure that your confidential account and transaction related information
are delivered to the mobile phone no. and email address which are only accessible by you.

2 of 10
B. INITIAL INVESTMENT OPTION
Please make ONE choice below and tick  the appropriate box. If you do not wish to make a fund choice, or if this section is left blank, or if
there is no signature of the employee provided in Part III, your contributions will be invested in accordance with the DIS, then the DIS will be
effected automatically. 

(I) DIS
Your future contributions and accrued benefits transferred from another Registered Scheme3 will be invested in accordance with the DIS. Please refer to
the ‘MPF Scheme Brochure’ for details. 3

Fund
Name of Constituent Fund Type of fund Investment allocation percentage
Code

Core Accumulation Fund

Mixed Assets Fund CAF 100%
The DIS is invested in the Core Accumulation Fund and the Age 65 Plus Fund according to the
pre-set allocation percentages at different ages and will adjust risk by way of reducing the
holding in the Core Accumulation Fund and increasing the holding in the Age 65 Plus Fund when
Age 65 Plus Fund the member gets older. For more details on de-risking of the DIS, please refer to the ‘MPF
Mixed Assets Fund APF Scheme Brochure’.
65 65 65

Or
(II) Own investment option
Please indicate which of the following Constituent Fund(s) you would like your future contributions and accrued benefits transferred from another
Registered Scheme3 under SuperTrust Plus be invested. The investment allocation percentages should be in whole numbers (e.g. 50% not 50.5%) and the
total should be 100%. If the total allocation is not 100%, your contributions will be invested in accordance with the DIS.
3
50% 50.5% 100%
100%
Investment allocation percentage

(Please counter-sign for any

Name of Constituent Fund Type of fund Fund code amendments made.
)

MPF Conservative Fund Money Market Fund CPF %

Global Bond Fund Bond Fund GBF %
Guaranteed Fund4 4
Guaranteed Fund GTF %
Age 65 Plus Fund 65 5 5
Mixed Assets Fund FMF %
(without de-risking nature )
Core Accumulation Fund5 5
Mixed Assets Fund SGF %
(without de-risking nature )
Stable Fund Mixed Assets Fund SBF %
Balanced Fund Mixed Assets Fund BLF %
Growth Fund Mixed Assets Fund GRF %
Global Equity Fund Equity Fund GEF %
North American Equity Fund Equity Fund NAEF %
European Equity Fund Equity Fund EUEF %
Asia Pacific Equity Fund Equity Fund ANEF %
Hong Kong and Chinese Equity Fund Equity Fund HKEF %
Chinese Equity Fund Equity Fund CNEF %
ValueChoice Balanced Fund Mixed Assets Fund VBLF %
ValueChoice North America Equity Tracker Fund
Equity Fund VUEF %

ValueChoice Europe Equity Tracker Fund

Equity Fund VEEF %

ValueChoice Asia Pacific Equity Tracker Fund

Equity Fund VAEF %

Hang Seng China Enterprises Index Tracking Fund

Equity Fund HSHF %

Hang Seng Index Tracking Fund Equity Fund HSIF %

Total 100%
3
If the asset is transferred from one account to another account or a personal account within the same HSBC MPF scheme, the fund allocation (i.e. units under respective Constituent Funds) of such asset
will remain unchanged until asset switching instruction is received from you.
IN61 v40/0624 (0624) H

4
For information about the Guaranteed Interest Rate, please visit or call our Customer Service Representative on 3128 0128.
3128 0128
5
If you choose to invest in the Core Accumulation Fund and/or the Age 65 Plus Fund (as a standalone investment fund rather than as part of the DIS), those investments will not be subject to the de-risking
process. 65

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C. TAX RESIDENCY SELF-CERTIFICATION (MANDATORY)
Please read the following instructions before completing this section

Why are we asking you to complete this section?

To help protect the integrity of tax systems, governments around the world are introducing a new information-gathering and reporting requirement for
financial institutions. This is known as the Common Reporting Standard (the “CRS”).
CRS

Under the CRS, we are required to determine where you are a “tax resident” (this will usually be where you are liable to pay income taxes). If you are a tax
resident outside the jurisdiction where your account is held, we may need to give the national tax authority this information, along with information
relating to your accounts. That may then be shared between different jurisdictions’ tax authorities. CRS

Completing this section will ensure that we hold accurate and up to date information about your tax residency.

If your circumstances change and any of the information provided in this section becomes incorrect, please let us know immediately and provide an
updated ‘Individual Tax Residency Self-Certification Form (CRS-I (HK)-MPF)’.
(CRS-I (HK)-MPF)

Where to go for further information?

If you have any questions about this section, please call our MPF hotline 2583 8033 (Employer) or 3128 0128 (Member).
2583 8033 3128 0128

The Organisation for Economic Co-operation and Development (“OECD”) has developed the rules to be used by all governments participating in the CRS
and these can be found on the OECD’s Automatic Exchange of Information (“AEOI”) website, .
CRS AEOI

Please also visit the website of the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region that sets out
information relating to the implementation of AEOI in Hong Kong: . Meaning of terms and expressions used in this
form (e.g. “account holder” and “reportable account”) may be found under Section 50A of the Inland Revenue Ordinance (Cap. 112).
AEOI
112 50A

If you have any questions on how to define your tax residency status, please visit the OECD website, or speak to
your tax advisor as we are not allowed to give tax advice.

Important Notes

• This is a self-certification provided by an account holder to a reporting financial institution for the purpose of automatic exchange of financial account
information. The data collected may be transmitted by the reporting financial institution to the Inland Revenue Department for transfer to the tax
authority of another jurisdiction.

• An account holder should report all changes in his/her tax residency status to the reporting financial institution.

• If space provided is insufficient, continue on additional sheet(s). Information in Section A & C of Part I marked with an asterisk (*) are required to be
reported by the reporting financial institution to the Inland Revenue Department. A C *

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C. TAX RESIDENCY SELF-CERTIFICATION (MANDATORY) (CONT‘D)
This section should be completed by account holder.
The below tick box is only for if the account holder’s Tax Residency Self-Certification is completed by employer, otherwise, please leave it blank+
+


 (i) the employer is authorised by the account holder identified in Section A of Part I of this form; (ii) the account holder is unable to complete this form due to exceptional
circumstance; (iii) the Tax Residency Self-Certification information is provided by the account holder. (i) A (ii)
(iii)

+
Please note that

i. pre-approval is required before you complete this section on behalf of the account holder identified in Section A of Part I of this form. If you have any questions about
this, please call our MPF hotline 2583 8033 (Employer). A
2583 8033

ii. the below information about the account holder’s Tax Residency Self-Certification you completed must be provided by the account holder identified in Section A of
Part I of this form. A

iii. the Trustee may request you to provide the original copy of documentary evidence with authorisation by the account holder identified in Section A of Part I of this form
if necessary. A

iv. if there are changes in the information, please remind the account holder to update the Trustee within 30 days of such change in circumstances.
30

Important note
If the account holder’s Tax Residency Self-Certification is completed by employer, please read the declaration and sign on Part IV ‘Declaration and
authorisation’. Please do not sign on Part III.

(1) The Tax Residence of account holder is Hong Kong SAR ONLY, with no tax residence in any other jurisdictions/countries/regions AND the HKID number
is his/her TIN.

 Yes (you may skip (2). (2) )

 No (please complete (2). (2) )

(2) Complete the following table indicating

(a) all jurisdictions where the account holder is a resident for tax purposes; and

(b) the account holder’s TIN for each jurisdiction indicated.

If the account holder is a tax resident of Hong Kong SAR, the TIN is the Hong Kong Identity Card Number (HKID).

If a TIN is unavailable, provide the appropriate reason A, B or C

#
Reason A - The jurisdiction where the account holder is a resident for tax purposes does not issue TINs to its residents.
A -

Reason B - The account holder is unable to obtain a TIN. Explain why the account holder is unable to obtain a TIN if you have selected this
reason.
B -

Reason C - TIN is not required. Select this reason only if the authorities of the jurisdiction of tax residence do not require the TIN to be
disclosed.
C -

#
Enter Reason A, B or C Explain why the account holder is unable
Jurisdiction of
TIN* if no TIN is available to obtain a TIN if you have selected Reason B
Tax Residence*
* B
*
A B C

4
IN61 v40/0624 (0624) H

5 of 10
PART II – EMPLOYER SECTION – (to be completed by employer )
1. Employer ID 2. Company name of participating employer (in English)

3. Employee’s date of employment 4. Pay centre ID 5. Class ID

’Daily pay centre’ only applicable to catering or construction

industry with casual employee.
Year Month Day
6. Please tick  the appropriate box only if employee is the categorised type. If this section is left blank, the member will be categorised as neither a casual
employee nor an expatriate employee. 

 Casual Employee (means a relevant employee who is employed on a day to day basis or for a fixed period of less than 60 days and
engaged in the catering or construction industry. 60 )
Expatriate employee6 6
who has been granted an employment visa for permission to work in Hong Kong for a period of 13 months or less.
13

 Yes (Please provide arrival date in Hong Kong and employment visa issue date. )

Arrival date in Hong Kong Employment visa issue date

Year Month Day Year Month Day

 No
6
Please refer to Schedule 1 of the MPF Scheme Ordinance for details of the Exempt Person. 1

7. Please tick  the appropriate box and select ONE only. If this section is left blank, the member will be regarded as a newly enrolled member.


 Newly enrolled member

 Member transferring from MPF Exempted ORSO Scheme
Date joined an MPF scheme of the employer
Year Month Day

 Employer scheme transfer

–
– member transferring from another MPF scheme due to change of scheme service provider by current
employer

Date first joined an MPF

scheme of the employer Effective date of transfer
Year Month Day Year Month Day

 Member transfer – member transferring from

–
another MPF scheme due to change of employment between associated companies
or change of business ownership

First date joined employer group7

7 Year Month Day
7
Years of service for the calculation of the member’s vesting entitlement will be counted from the above date.

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6 of 10
PART III – DECLARATION AND AUTHORISATION –
(only applicable if ‘Part I(C) – Tax Residency Self-Certification’ is completed by account holder
C – )

Personal information collection statement

1. Personal data provided by Participating Employers and/or Members and details of transactions or dealings by such Participating Employers and/or
Members from time to time may, to the extent not prohibited by applicable law, be used for one or more of the following purposes: - (i) the
administration and/or management of or in connection with the contributions or accrued benefits or MPF account in respect of the Participating
Employers and/or Members under the HSBC MPF scheme and Hang Seng MPF scheme administered by the HSBC Group; (ii) conducting direct
marketing activities of MPF products and/or MPF services by entities of the HSBC Group as described in paragraph 5 below only if your consent is
obtained (which includes an indication of no objection); (iii) improving and furthering the provision of MPF products and/or MPF services (including
through customer research or surveys) by entities of the HSBC Group; (iv) matching for MPF related purpose with other personal data concerning the
relevant Participating Employers and/or Members; (v) compliance or in accordance with an order of a court or compliance or in accordance with a law
or a requirement made under a law (e.g. the Inland Revenue Ordinance and its provisions including those concerning automatic exchange of financial
account information) or compliance or in accordance with any guidelines, guidance or requests given or issued by the Inland Revenue Department
including those concerning automatic exchange of financial account information.
(i)
(ii)
5 (iii)
(iv)
(v)

2. Failure to provide your information may result in us being unable to process your application or perform the services you request.

3. Personal data held by us relating to a Participating Employer and/or Member will be kept confidential but, to the extent not prohibited by applicable law,
such information may be provided by us or any of our service providers to the following parties for the purposes set out in paragraph 1:- (i) any
regulators or government authorities; (ii) any service provider, agent or contractor who provides administrative, telecommunications, computer,
payment, data processing, matching, storage, customer research or survey or other services in connection with the operation of our MPF business;
(iii) relevant Participating Employers; (iv) entities of the HSBC Group. Such information may be transferred to a place outside Hong Kong Special
Administrative Region.
1 (i) (ii)
(iii) (iv)

4. You have the right to request access to and correction of your personal data held by us. Request should be addressed to: The Data Protection Officer,
HSBC Provident Fund Trustee (Hong Kong) Limited, c/o The Hongkong and Shanghai Banking Corporation Limited, PO Box 73770, Kowloon Central
Post Office. 73770 c/o
HSBC Provident Fund Trustee (Hong Kong) Limited

5. To the extent not prohibited by applicable law, we, entities of the HSBC Group, intend to use your personal data in direct marketing of MPF products
and/or MPF services, and we require your consent (which includes an indication of no objection) for that purpose. In this connection, please note that:

(i) your name, contact details, other products and services portfolio information, transaction pattern and behaviour, financial background and
demographic data held by us from time to time may be used in direct marketing; and

(ii) the MPF products and/or MPF services offered by entities of the HSBC Group may be marketed.

If you no longer want us to use your personal data in direct marketing activities as described in paragraph 5 above, you may exercise your opt-out right
by notifying us. 5

 Please tick if you do not wish your personal data to be used for purpose of conducting direct marketing activities stated in paragraph
5 above. 5

The above represents your present choice whether or not to receive direct marketing contact or information. This replaces any choice communicated by
you to us prior to this application. Please note that you can change your marketing preference anytime, by calling us on (852) 2583 8033 (Employer) or
(852) 3128 0128 (Member), to receive our best offers and promotions.
(852) 2583 8033 (852) 3128 0128
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7 of 10
PART III – DECLARATION AND AUTHORISATION (CONT‘D) –
(only applicable if ‘Part I(C) – Tax Residency Self-Certification’ is completed by account holder
C – )

Signature of employee

Participation — by signing this form, I —

a) understand that the investment allocation as specified in Section B of Part I will be applied to all contributions including any monies transferred into
SuperTrust Plus, and B

b) declare I have read and understood the MPF Scheme Brochure, and

c) agree to comply with the Master Trust Deed of the scheme, and

d) confirm having read and understood the personal information collection statement above, and

e) authorise the Participating Employer to deduct mandatory contribution and additional voluntary contribution (if applicable) from my relevant income and
remit them to the Trustee, and

f) acknowledge and agree that (i) the information contained in this form is collected and may be kept by HSBC Provident Fund Trustee (Hong Kong) Limited
(the “Trustee”) for the purpose of automatic exchange of financial account information, and (ii) such information and information regarding the
account holder and any reportable account(s) may be reported by the Trustee to the Inland Revenue Department of the Government of the Hong Kong
Special Administrative Region and exchanged with the tax authorities of another jurisdiction(s) in which the account holder may be resident for tax
purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112), and
HSBC Provident Fund Trustee (Hong Kong) Limited 112
(i) (ii)

g) undertake to advise the Trustee of any change in circumstances which affects the tax residency status of the individual identified in Section A of Part I
of this form or causes the information contained herein to become incorrect, and to provide the Trustee with a suitably updated ‘Individual Tax
Residency Self-Certification Form (CRS-I (HK)-MPF)’ within 30 days of such change in circumstances, and
A 30
(CRS-I (HK)-MPF)

h) confirm that the account holder to which this form relates has provided ALL the countries/jurisdictions in which the account holder is tax resident due
to the applicable tax residency regulations, local laws or treaties, and

i) declare that the information given and statements made in this form are, to the best of my knowledge and belief, true, correct and complete.

x
Signature of employee Full name Date
(This signature will be used to verify your future correspondence to us. )

Authorised signature of employer

By signing this form, I/We declare that the information given by me/us and statements made in this form are, to the best of my/our knowledge and belief,
true, correct and complete.

x
Authorised signature of employer Full name Date
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8 of 10
PART IV – DECLARATION AND AUTHORISATION –
(only applicable if ‘Part I(C) – Tax Residency Self-Certification’ is completed by employer
C – )
Note: If employee has signed Part III ‘Signature of employee’, then the ‘Tax Residency Self-Certification’ in Section C of Part I will be treated
as completed by account holder (i.e. employee) instead of employer. Therefore, employer is not required to complete this part.
C

Personal information collection statement

1. Personal data provided by Participating Employers and/or Members and details of transactions or dealings by such Participating Employers and/or
Members from time to time may, to the extent not prohibited by applicable law, be used for one or more of the following purposes: - (i) the
administration and/or management of or in connection with the contributions or accrued benefits or MPF account in respect of the Participating
Employers and/or Members under the HSBC MPF scheme and Hang Seng MPF scheme administered by the HSBC Group; (ii) conducting direct
marketing activities of MPF products and/or MPF services by entities of the HSBC Group as described in paragraph 5 below only if your consent is
obtained (which includes an indication of no objection); (iii) improving and furthering the provision of MPF products and/or MPF services (including
through customer research or surveys) by entities of the HSBC Group; (iv) matching for MPF related purpose with other personal data concerning the
relevant Participating Employers and/or Members; (v) compliance or in accordance with an order of a court or compliance or in accordance with a law
or a requirement made under a law (e.g. the Inland Revenue Ordinance and its provisions including those concerning automatic exchange of financial
account information) or compliance or in accordance with any guidelines, guidance or requests given or issued by the Inland Revenue Department
including those concerning automatic exchange of financial account information.
(i)
(ii)
5 (iii)
(iv)
(v)

2. Failure to provide your information may result in us being unable to process your application or perform the services you request.

3. Personal data held by us relating to a Participating Employer and/or Member will be kept confidential but, to the extent not prohibited by applicable law,
such information may be provided by us or any of our service providers to the following parties for the purposes set out in paragraph 1:- (i) any
regulators or government authorities; (ii) any service provider, agent or contractor who provides administrative, telecommunications, computer,
payment, data processing, matching, storage, customer research or survey or other services in connection with the operation of our MPF business;
(iii) relevant Participating Employers; (iv) entities of the HSBC Group. Such information may be transferred to a place outside Hong Kong Special
Administrative Region.
1 (i) (ii)
(iii) (iv)

4. You have the right to request access to and correction of your personal data held by us. Request should be addressed to: The Data Protection Officer,
HSBC Provident Fund Trustee (Hong Kong) Limited, c/o The Hongkong and Shanghai Banking Corporation Limited, PO Box 73770, Kowloon Central
Post Office. 73770 c/o
HSBC Provident Fund Trustee (Hong Kong) Limited

5. To the extent not prohibited by applicable law, we, entities of the HSBC Group, intend to use your personal data in direct marketing of MPF products
and/or MPF services, and we require your consent (which includes an indication of no objection) for that purpose. In this connection, please note that:

(i) your name, contact details, other products and services portfolio information, transaction pattern and behaviour, financial background and
demographic data held by us from time to time may be used in direct marketing; and

(ii) the MPF products and/or MPF services offered by entities of the HSBC Group may be marketed.

If you no longer want us to use your personal data in direct marketing activities as described in paragraph 5 above, you may exercise your opt-out right
by notifying us. 5

 Please tick if you do not wish your personal data to be used for purpose of conducting direct marketing activities stated in paragraph
5 above. 5

The above represents your present choice whether or not to receive direct marketing contact or information. This replaces any choice communicated
by you to us prior to this application. Please note that you can change your marketing preference anytime, by calling us on (852) 2583 8033 (Employer)
or (852) 3128 0128 (Member), to receive our best offers and promotions.
(852) 2583 8033 (852) 3128 0128
IN61 v40/0624 (0624) H

9 of 10
PART IV – DECLARATION AND AUTHORISATION (CONT‘D) –
(only applicable if ‘Part I(C) – Tax Residency Self-Certification’ is completed by employer
C – )

Authorised signature of employer

By signing this form, I/We

a) certify that I am/We are authorised to sign in the capacity of the employer authorised by the account holder who is the individual identified in Section A
of Part I of this form, and A

b) confirm having read and understood the personal information collection statement above, and

c) acknowledge and agree that (i) the information contained in this form is collected and may be kept by HSBC Provident Fund Trustee (Hong Kong) Limited
(the “Trustee”) for the purpose of automatic exchange of financial account information, and (ii) such information and information regarding the
account holder and any reportable account(s) may be reported by the Trustee to the Inland Revenue Department of the Government of the Hong Kong
Special Administrative Region and exchanged with the tax authorities of another jurisdiction(s) in which the account holder may be resident for tax
purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112), and
HSBC Provident Fund Trustee (Hong Kong) Limited 112
(i) (ii)

d) acknowledge and agree that the Trustee may request me/us to provide the original copy of documentary evidence with authorisation by the account
holder identified in Section A of Part I of this form if necessary, and A

e) confirm that the account holder to which this form relates has provided ALL the countries/jurisdictions in which the account holder is tax resident due
to the applicable tax residency regulations, local laws or treaties, and

f) declare that the information given by me/us and statements made in this form are, to the best of my/our knowledge and belief, true, correct and
complete.

x
Authorised signature of employer (for CRS purpose) Full name Date
CRS

WARNING: It is a serious offence under the Inland Revenue Ordinance if any person, in making a self-certification, makes a statement
that is misleading, false or incorrect in a material particular AND knows, or is reckless as to whether, the statement is misleading, false or
incorrect in a material particular. Heavy penalty may apply upon conviction.

IN61 v40/0624 (0624) H

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