Scribd Logo
Upload

Welcome to Scribd!

  • 148 views

    Employees Compensation A D of Earnings Form - 0514

    Uploaded by

    waterwood3388
    This document is an Employees' Compensation Insurance Premium Adjustment and Declaration of Earnings Form from Prudential General Insurance Hong Kong Limited. It requests information from the insured such as the number of employees, their occupations, total earnings, and other details for the purpose of adjusting insurance premiums. Guidelines are provided on the back page for completing the form, including defining the period of insurance and requirements for submission.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Employees Compensation A D of Earnings Form - 0514

    Uploaded by

    waterwood3388
    148 views2 pages
    This document is an Employees' Compensation Insurance Premium Adjustment and Declaration of Earnings Form from Prudential General Insurance Hong Kong Limited. It requests information from the insured such as the number of employees, their occupations, total earnings, and other details for the purpose of adjusting insurance premiums. Guidelines are provided on the back page for completing the form, including defining the period of insurance and requirements for submission.

    Original Description:

    compensation policy

    Original Title

    Employees Compensation A D of earnings Form_0514

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is an Employees' Compensation Insurance Premium Adjustment and Declaration of Earnings Form from Prudential General Insurance Hong Kong Limited. It requests information from the insured such as the number of employees, their occupations, total earnings, and other details for the purpose of adjusting insurance premiums. Guidelines are provided on the back page for completing the form, including defining the period of insurance and requirements for submission.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    148 views2 pages

    Employees Compensation A D of Earnings Form - 0514

    Uploaded by

    waterwood3388
    This document is an Employees' Compensation Insurance Premium Adjustment and Declaration of Earnings Form from Prudential General Insurance Hong Kong Limited. It requests information from the insured such as the number of employees, their occupations, total earnings, and other details for the purpose of adjusting insurance premiums. Guidelines are provided on the back page for completing the form, including defining the period of insurance and requirements for submission.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Prudential General Insurance Hong Kong Limited 保誠財險有限公司

    (A member of Prudential plc group) ( 英國保誠集團成員 )


    3/F, Berkshire House, 25 Westlands Road 香港鰂魚涌華蘭路 25 號
    Quarry Bay, Hong Kong 栢克大廈 3 樓

    Tel : (852) 2977 3888 電話：(852) 2977 3888


    Fax : (852) 2164 8445 傳真：(852) 2164 8445

    EMPLOYEES’ COMPENSATION INSURANCE


    僱員補償保險
    PREMIUM ADJUSTMENT & DECLARATION OF EARNINGS FORM
    保費調整及薪金申報表

    N.B. PLEASE SEE OVERLEAF FOR GUIDELINES FOR COMPLETING THIS FORM
    注意︰在塡寫本表格時，請留意背頁所列指引。

    The Insured Policy Number Period of Insurance(a)


    投保人 保單號碼 保障期(a)

    / / - / /

    Description of Occupations(b) (c)


    Number of Persons Employed Total Earnings (HK Dollars)
    (b) (c)
    受聘人員數目 職業類別 總薪金 (港幣)

    TOTAL 合計

    PLEASE COMPLETE THE FOLLOWING IF THIS POLICY IS TO PROTECT EMPLOYEES OF CONTRACTOR(S)/


    SUBCONTRACTOR(S)(d).
    如本保單涉及為承辦商/次承辦商(d)的僱員提供保障，請塡寫下列資料。

    Name of Contractor(s)/ Total Amount Paid/ Payable to Contractor(s)/


    Nature of Works sub-contracted
    Sub-contractor(s) Sub-contractor(s) for the Period of Insurance
    外判工程的性質
    承辦商/次承辦商名稱 保障期內已支付及將支付予承辦商/次承辦商的金額

    TOTAL 合計
    Pursuant to the Insurance Premium Clause of the abovementioned Policy, I/we affirm that the above amount of all
    earnings paid by me/us to every employee in my/our employment during the said Period of Insurance is true and correct
    to the best of my/our knowledge.
    承上述保單保險費條款所要求，以上所列乃在有關保障期內，所有獲本人/吾等聘用的每位僱員所支取全部薪金的資料，本
    人/吾等確認一切均為正確無誤，及以本人/吾等所知悉範圍內提供。
    GI3/FR00114B/P01 (05/14)

    Signature of Insured 投保人簽署 Name & title of person signing 簽署人姓名及職位


    company chop (where applicable) 公司蓋印 (如適用)

    Date 日期
    IMPORTANT NOTICE
    重要事項

    (1) Any employer who fails to insure himself in accordance with Section 40(1) of the Employees’
    Compensation Ordinance (Chapter 282) shall be guilty of an offence and shall be liable on
    conviction to a maximum fine of HK$100,000 and imprisonment for two years.
    任何僱主如未有依僱員補償條例（282 章）40 條（1）所要求投保，即屬違法，最高將被罰款港幣
    100,000 元 及監禁 2 年。
    (2) You are required under the policy conditions to furnish the Premium Adjustment & Declaration of
    Earnings Form to your Insurance Company within the stipulated time (see Guidelines (e) below),
    stating the actual Earnings of Employees and provide the relevant supporting documents during
    the Period of Insurance. The actual Earnings of Employees declared shall be taken as the
    Estimated Earnings of the Employees employed during the next period of insurance immediately
    subsequent to this renewal.
    在本保單的條款下，您必須在指定時間內（詳請見下述指引(e)所示），提交載有保障期內僱員實際
    薪金資料的「保費調整及薪金申報表」予您的保險公司，並提供有關的支持文件。所申報的僱員實
    際薪金資料，將用作計算在本續保後下一個保障期的僱員預期薪金。

    GUIDELINES FOR COMPLETING THE


    PREMIUM ADJUSTMENT & DECLARATION OF EARNINGS FORM
    塡寫保費調整及薪金申報表指引

    (a) Period of Insurance 保障期


    The Current Period of Insurance as shown on the Renewal Notice with which this Form is
    presented.
    隨本申報表一併發出的續保通知書上所載有的現有保障期。
    (b) Description of Occupations 職業類別
    Each category of occupation is to be shown separately e.g. Clerical Staff, Sales/Marketing,
    Messenger, Lorry Driver, Welder etc.
    請將各職業類別逐一列舉出來，如文職人員、銷售/市場推廣、信差、貨車司機、焊工等。
    (c) Total Earnings (As more fully defined under Section 3 of the Employees’ Compensation
    Ordinance (Chapter 282) 總薪金（在僱員補償條例（282 章）3 條中有更詳細解釋）
    Please declare the actual total gross earnings for the period of insurance.
    請申報在保障期內的實際總薪金。
    (d) Contractors & Sub-contractor’s Employees 承辦商/次承辦商的僱員
    If you contract out any of the work in connection with your business, please provide particulars as
    specified therein.
    如您就業務將工程外判，請詳細列明。
    (e) Submission of this Form 交回本表
    You have to complete the Premium Adjustment & Declaration of Earnings Form and submit it
    within 90 days after the expiry or termination of the policy together with the following:
    您必須在本保單到期日或被中止日後的 90 天內，塡寫本保費調整及薪金申報表，並連同下列各項一
    併交回︰
    i) Signature of an authorized officer.
    獲授權人士簽署
    ii) Monthly MPF Contribution Statements for the Period of Insurance (stating the occupation of
    each employee).
    就保障期強積金的每月供款賬單（需列明每名僱員的職業）

    You might also like