"Scheme $6,000" Registration Form (For Direct Bank Transfer To Registrant's Bank Account)
"Scheme $6,000" Registration Form (For Direct Bank Transfer To Registrant's Bank Account)
"Scheme $6,000" Registration Form (For Direct Bank Transfer To Registrant's Bank Account)
Note : 1. Please read the Scheme $6,000 Guidance Notes overleaf before completing this registration form (this Form). 2. Please complete this Form in BLOCK letters using black or blue pen.
Part 1 Personal Particulars of Registrant
( ) Local Contact Telephone No. Chinese Name (if applicable) English Name as shown on the HK Permanent Identity Card Bank Reference No. (For Bank Use Only)
Part 2
Please pay direct to my bank account as specified (Name of bank) Account Number as shown in passbook or bank statement (Must be Registrants local HKD sole-name savings/current account)
Part 3 Declaration and Undertaking of Registrant 1. I, the undersigned, declare that I am the holder of Hong Kong Permanent Identity Card (HKPIC) number as given in Part 1 of this Form. 2. I have read the following Personal Information Collection Statement and fully understand its content. Personal Information Collection Statement Purpose of Collection The information provided in this Form and other information that may be provided for the purposes of Scheme $6,000 (the Data) will be used by the Government of the Hong Kong Special Administrative Region (the Government) and its agents/contractors for one or more of the following purposes and any directly related purpose, in respect of Scheme $6,000 and other scheme(s) if any operated for the same purpose as Scheme $6,000 (hereinafter referred to such scheme(s)) : (i) to process your registration and payment, if applicable, under such scheme(s) (including but not limited to the process(es) referred to in this Part) and if required, to communicate with you for matters relating to such scheme(s); (ii) to conduct matching between the Data and the personal data held by the Government including the Immigration Department to check your eligibility under such scheme(s); (iii) to administer such scheme(s) including but not limited to effecting payment to you, issuing written notifications to you and conducting the investigations referred to in paragraph 4 in this Part; (iv) for statistics purposes on the condition that the resulting statistics will not be made available in a form which will identify the data subjects or any of them; and (v) any other purposes as may be required, authorised or permitted by law. It is voluntary for you to supply the Data but if you fail to supply any of the data required by this Form, your registration may not be processed. Classes of Transferees The Data you provide may be disclosed to relevant bureaux and departments of the Government, their agents/contractors including but not limited to the Treasury, Immigration Department, Hongkong Post, Financial Services and the Treasury Bureau, banks and other transferees and any other parties as stipulated in this Part for the purposes stated in this Form. Access to Personal Data Except where there is an exemption provided under the Personal Data (Privacy) Ordinance (Cap. 486), you have the right to request access to and correction of your personal data provided in this Form when the data have not been erased. Your right of access includes the right to obtain a copy of your personal data provided in this Form subject to payment of a fee. Request and Enquiry Your request for access to personal data or enquiry of personal data privacy policy should be addressed by fax (no. 3752 6641) or by post to Personal Data Privacy Officer, Scheme $6,000 Secretariat, GPO Box 181234, Hong Kong. 3. I hereby authorise and consent to my bank as specified in this Form and its agents/contractors operating in or outside Hong Kong using my personal data in their possession including my name, HKPIC number, bank account number and address; and releasing such data to the relevant bureaux and departments, including their agents/contractors, of the Government to process my registration and receipt of payment under such scheme(s) and for any purpose directly related to such purposes. Such bureaux/departments of the Government include, but are not limited to, the Treasury, Immigration Department, Hongkong Post, Financial Services and the Treasury Bureau, and other relevant government offices involved in the administration and operation of such scheme(s). 4. I also consent to the use of the Data for any checking and/or investigation relating to my registration and receipt of payment under such scheme(s) to be carried out by the relevant bureaux/departments of the Government mentioned in paragraph 3 above, including their agents and contractors, and that they may disclose the Data to any other parties if the disclosure is necessary for such checking and/or investigation. 5. I also consent to the matching of the Data with my personal data held by the Immigration Department (including but not restricted to personal data kept under the Registration of Persons Ordinance (Cap. 177)) and/or other bureaux/departments and/or their agents/contractors in relation to my registration and receipt of payment under such scheme(s), and understand that the matching procedure is conducted for ascertaining whether I am eligible under such scheme(s) or not, and therefore I will not receive payment under such scheme(s) in case I am ineligible. 6. I agree that the payment under such scheme(s) be effected to me directly into my bank account as specified in this Form. I also agree and undertake to notify the Government forthwith of any overpayment to me under such scheme(s) and refund the same to the Government. In this respect, I hereby authorise my bank to debit my bank account with such amount certified by the Government as overpayment. 7. I declare that the Data is true and correct. I understand that if I knowingly or wilfully make any false statement or withhold any information, or otherwise mislead the Government for the purpose of obtaining payments under such scheme(s), it will render me liable to prosecution.
Date ___________________________________________________
S6K-1(E)
C L U K
6 8 8 6 8 8 C H I N
4 5 6 7 8 9 0 1
Chinese Name (if applicable)
Y U E N
Part 2 Bank Account Details of Registrant (For Direct Bank Transfer Use)
Please pay direct to my bank account X X Bank as specified (Name of bank) Account Number as shown in passbook or bank statement (Must be Registrants local HKD sole-name savings/current account)
Q N B
MF
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