Cash Payout Scheme Registration Form (For Cheque Payment ... · 1. Eligibility Criteria PO C Hong...
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HKSAR Government CPS-2(E) (Page 1 of 3) Cash Payout Scheme Registration Form (For Cheque Payment to Registrant) Notes: 1. Please read the Guidance Notes overleaf before completing this registration form (“Form”). 2. Please use a non-erasable black or dark blue ball pen to fill in this Form in BLOCK letters. For any amendments, please initial next to them, and do not use correction fluid or correction tape. Reference No. (For Hongkong Post Use Only) 2 Part 1 Personal Particulars of Registrant HK Permanent Identity Card No. ( ) Local Contact Telephone No. (local SMS-enabled mobile phone no. preferred) English Name as shown on the HK Permanent Identity Card Local Correspondence Address Chinese Name (if applicable) # 1. HK / 2. KLN / 3. NT Part 2 Cheque Collection Location (Please refer to the post office codes and addresses on page 3.) I shall collect the cheque at the post office specified below. Post Office Code ( ) Part 3 Declaration and Undertaking of Registrant 1. 2. 3. 4. 5. 6. I, the undersigned, declare that I am the holder of Hong Kong Permanent Identity Card (“HKPIC”) number as specified in Part 1 of this Form. I have read and fully understand the content of the following “Personal Information Collection Statement”. Personal Information Collection Statement How your Data will be used Your information and personal data provided in this Form and other information that may be provided by you in relation to the Cash Payout Scheme (collectively referred to as “the Data”) will be used for the purpose of: (i) effecting cash handouts under the Cash Payout Scheme; and (ii) effecting cash/non-cash handouts/refunds (if any) under schemes administered by the Hong Kong Special Administrative Region Government (“the Government”) in future that are aimed at, amongst other things, encouraging local consumption, relieving people’s financial burden, and/or returning wealth to the people (“Other Schemes”). The purposes mentioned above are collectively referred to as “Purposes”; and the Cash Payout Scheme and Other Schemes are collectively referred to as “Such Schemes”. The Data will be used: (i) to process your registration (if applicable) of and to administer the handouts/refunds under Such Schemes (including but not limited to the process(es) referred to in (ii) and (iii) below); (ii) to communicate with you on matters relating to the Purposes, including but not limited to sending SMS notifications, issuing written notifications and effecting handouts/refunds to you; (iii) to conduct matching between the Data and the personal data held by the Government to check your eligibility under Such Schemes; (iv) for statistics purposes on the condition that the resulting statistics will not be made available in a form which will identify individual registrants (i.e. the data subjects); and (v) for any other purposes as may be required, authorised or permitted by law. It is voluntary for you to supply the data required by this Form. If you fail to supply any of the data required by this Form, your registration (if any) under Such Schemes may not be processed or you may not receive the handouts/refunds under Such Schemes. Transfer and/or Disclosure of the Data (i) The Data will be transferred to and used by relevant bureaux and departments of the Government including but not limited to the Treasury, Office of the Government Chief Information Officer, Immigration Department, Hongkong Post and Financial Services and the Treasury Bureau (“the relevant bureaux and departments”), as well as their agents/contractors operating in or outside Hong Kong, for the Purposes; and (ii) The Data will be disclosed to agencies which are authorised to receive information relating to law enforcement, prosecution or review of the decisions regarding your eligibility under Such Schemes. Data Access Requests (i) You have the right to request for access to and correction of the personal data provided in this Form under the Personal Data (Privacy) Ordinance (Cap 486) (the “Ordinance”), subject to any relevant exemption(s); (ii) Please note that a data access request shall or may be refused in the circumstances specified in section 20 of the Ordinance; and (iii) Your requests or enquiries should be made by any one of the following means: (a) by email to [email protected]; (b) by fax to 3106 0701; or (c) by post to GPO Box 180000, Hong Kong. I hereby consent to the use of the Data for any checking and/or investigation relating to my registration (if any) and receipt of handouts/refunds under Such Schemes to be carried out by the relevant bureaux and departments, including their agents/contractors, and that they may disclose the Data to any other parties if the disclosure is necessary for such checking and/or investigation. I also consent to the matching of the Data with my personal data held by the relevant bureaux and departments and/or their agents/contractors, including but not limited to my personal data kept under the Registration of Persons Ordinance (Cap 177) by the Immigration Department, in relation to my registration (if any) and receipt of handouts/refunds under Such Schemes. I understand that the matching procedure is conducted for ascertaining whether I am eligible under Such Schemes or not, and therefore I will not receive handouts/refunds under Such Schemes in case I am ineligible. I agree and undertake to notify the Government forthwith of any overpayment or any payment or refund by mistake to me under Such Schemes and to repay or refund the same to the Government. I declare that the information and personal data provided in this Form is true and correct. I understand that if I knowingly or wilfully make any false statement, withhold any information, or otherwise mislead the Government for the purpose of obtaining handouts/refunds under Such Schemes, I will be liable for prosecution. Signature of Registrant Date #Delete whichever is inappropriate. Please complete and return this Form by putting it in the Cash Payout Scheme drop-box at any post office or sending it by post to “GPO Box 182020, Hong Kong”. No postage stamp is necessary if posted in Hong Kong.
Transcript of Cash Payout Scheme Registration Form (For Cheque Payment ... · 1. Eligibility Criteria PO C Hong...
HKSAR Government CPS-2(E) (Page 1 of 3)
Cash Payout Scheme Registration Form (For Cheque Payment to Registrant) Notes: 1. Please read the Guidance Notes overleaf before completing this registration form (“Form”).2. Please use a non-erasable black or dark blue ball pen to fill in this Form in BLOCK letters. For
any amendments, please initial next to them, and do not use correction fluid or correction tape.
Reference No. (For Hongkong Post Use Only)
2 Part 1 Personal Particulars of Registrant
HK Permanent Identity Card No. ( ) Local Contact Telephone No. (local SMS-enabled mobile phone no. preferred)
English Name as shown on the HK Permanent Identity Card
Local Correspondence Address
Chinese Name (if applicable)
# 1. HK / 2. KLN / 3. NT
Part 2 Cheque Collection Location (Please refer to the post office codes and addresses on page 3.) I shall collect the cheque at the post office specified below.
Post Office Code ( )
Part 3 Declaration and Undertaking of Registrant
1. 2.
3.
4.
5.
6.
I, the undersigned, declare that I am the holder of Hong Kong Permanent Identity Card (“HKPIC”) number as specified in Part 1 of this Form. I have read and fully understand the content of the following “Personal Information Collection Statement”. Personal Information Collection Statement How your Data will be used Your information and personal data provided in this Form and other information that may be provided by you in relation to the Cash Payout Scheme (collectively referred to as “the Data”) will be used for the purpose of: (i) effecting cash handouts under the Cash Payout Scheme; and(ii) effecting cash/non-cash handouts/refunds (if any) under schemes administered by the Hong Kong Special Administrative Region Government (“the
Government”) in future that are aimed at, amongst other things, encouraging local consumption, relieving people’s financial burden, and/or returning wealth to the people (“Other Schemes”).
The purposes mentioned above are collectively referred to as “Purposes”; and the Cash Payout Scheme and Other Schemes are collectively referred to as “Such Schemes”. The Data will be used: (i) to process your registration (if applicable) of and to administer the handouts/refunds under Such Schemes (including but not limited to the process(es)
referred to in (ii) and (iii) below);(ii) to communicate with you on matters relating to the Purposes, including but not limited to sending SMS notifications, issuing written notifications
and effecting handouts/refunds to you;(iii) to conduct matching between the Data and the personal data held by the Government to check your eligibility under Such Schemes;(iv) for statistics purposes on the condition that the resulting statistics will not be made available in a form which will identify individual registrants (i.e.
the data subjects); and (v) for any other purposes as may be required, authorised or permitted by law.It is voluntary for you to supply the data required by this Form. If you fail to supply any of the data required by this Form, your registration (if any) underSuch Schemes may not be processed or you may not receive the handouts/refunds under Such Schemes.Transfer and/or Disclosure of the Data(i) The Data will be transferred to and used by relevant bureaux and departments of the Government including but not limited to the Treasury, Office of
the Government Chief Information Officer, Immigration Department, Hongkong Post and Financial Services and the Treasury Bureau (“the relevantbureaux and departments”), as well as their agents/contractors operating in or outside Hong Kong, for the Purposes; and
(ii) The Data will be disclosed to agencies which are authorised to receive information relating to law enforcement, prosecution or review of the decisionsregarding your eligibility under Such Schemes.
Data Access Requests (i) You have the right to request for access to and correction of the personal data provided in this Form under the Personal Data (Privacy) Ordinance
(Cap 486) (the “Ordinance”), subject to any relevant exemption(s);(ii) Please note that a data access request shall or may be refused in the circumstances specified in section 20 of the Ordinance; and(iii) Your requests or enquiries should be made by any one of the following means: (a) by email to [email protected]; (b) by fax to 3106 0701;
or (c) by post to GPO Box 180000, Hong Kong.I hereby consent to the use of the Data for any checking and/or investigation relating to my registration (if any) and receipt of handouts/refunds under Such Schemes to be carried out by the relevant bureaux and departments, including their agents/contractors, and that they may disclose the Data to any other parties if the disclosure is necessary for such checking and/or investigation. I also consent to the matching of the Data with my personal data held by the relevant bureaux and departments and/or their agents/contractors, including but not limited to my personal data kept under the Registration of Persons Ordinance (Cap 177) by the Immigration Department, in relation to my registration (if any) and receipt of handouts/refunds under Such Schemes. I understand that the matching procedure is conducted for ascertaining whether I am eligible under Such Schemes or not, and therefore I will not receive handouts/refunds under Such Schemes in case I am ineligible. I agree and undertake to notify the Government forthwith of any overpayment or any payment or refund by mistake to me under Such Schemes and to repay or refund the same to the Government. I declare that the information and personal data provided in this Form is true and correct. I understand that if I knowingly or wilfully make any false statement, withhold any information, or otherwise mislead the Government for the purpose of obtaining handouts/refunds under Such Schemes, I will be liable for prosecution.
Signature of Registrant
Date #Delete whichever is inappropriate.
Please complete and return this Form by putting it in the Cash Payout Scheme drop-box at any post office or sending it by post to “GPO Box 182020, Hong Kong”. No postage stamp is necessary if posted in Hong Kong.
HKSAR Government CPS-2(E) (Page 2 of 3)
Cash Payout Scheme Guidance Notes 1. Eligibility Criteria
The registrant should fulfil the eligibility criteria of the Cash Payout Scheme, i.e. on or before 31 March 2021, the registrant is aged 18 or above and is a Hong Kong permanent resident holding either a valid Hong Kong Permanent Identity Card or a Certificate of Exemption. For details of the eligibility criteria of the Cash Payout Scheme, please visit the website of the Scheme (www.cashpayout.gov.hk) or call the Enquiry Hotline 182020.
2. Registration (i) The registrant must provide his/her signature in this Form. Failure to provide the required information and the signature of the registrant
may result in non-processing of this Form. The registrant should provide a SMS-enabled local mobile phone number (if any) and local correspondence address for receiving notification(s) from Hongkong Post in relation to the registration. The registrant is advised to make reference to the sample below.
(ii) The duly completed Form should be submitted on or before 31 December 2021:
- in an envelope addressed to “GPO Box 182020, Hong Kong”. It is not necessary to affix stamps on the envelope if posted in Hong Kong (the postage will be borne by the Government).
(iii) Registrants may also register on-line via the website of Hongkong Post. (iv) Each registrant should submit only ONE registration under the Cash Payout Scheme and ensure accuracy of the information provided.
Duplicate registrations will not be processed. This Form, once submitted, cannot be withdrawn except with valid reasons. Subsequent amendment of information therein will delay the processing of registration and payment.
(v) Registrants will receive an acknowledgement of registration from Hongkong Post by SMS or post upon receipt of their registrations. In case it is necessary to clarify any information provided in this Form, Hongkong Post may contact the registrants by a designated phone number 2908 0070 or by post. Where necessary, e.g. in the event of inaccurate or incomplete information, the registrant may be requested to make a re-submission.
(vi) Registrants with their registration completed and eligibility confirmed will receive a notification by SMS or post informing them to collect the cheque. In case the registration is not successful, a notification will be sent to the registrant by SMS or post.
(vii) The default Post Office Code for cheque collection location is “GPO” if the registrant has not indicated any post office code, or he/she has indicated an incorrect Post Office Code in Part 2 (Cheque Collection Location) but the staff of Hongkong Post cannot successfully contact the registrant for clarification.
(viii) If the registrant fails to collect the cheque within 6 months from its date, a new cheque (“re-issued cheque”) will be issued automatically and be available for collection at the same post office. If the registrant still fails to collect the re-issued cheque within 6 months from its date, or despite having collected it, fails to encash it or deposit it with a bank before it becomes stale, he/she will be deemed to have forfeited his/her right to the cash handout under the Cash Payout Scheme.
3. Enquiries For enquiries, please call the Enquiry Hotline 182020. For Post Office codes and addresses, please refer to the list on page 3 or the website of Hongkong Post (www.hongkongpost.hk).
4. Prevention of Telephone Deception (i) Under no circumstances will the staff of Hongkong Post request for any personal information (i.e. address, Hong Kong Permanent Identity
Card number of the registrant) over the phone. (ii) If any member of the public is in doubt about the authenticity of a call allegedly from Hongkong Post and would like to seek clarifications,
please call the Hongkong Post Enquiry Hotline at 2921 2222.
- through the Cash Payout Scheme drop-box at any post office; or
HKSAR Government CPS-2(E) (Page 3 of 3)
List of Post Office (PO) Codes and Addresses PO Code PO Name PO Address PO Code PO Name PO Address
Hong Kong Kowloon ABD Aberdeen PO G/F, Kam Fung Building, 171 Aberdeen Main Road TWS Tsz Wan Shan PO Shop 330, 3/F, Tsz Wan Shan Shopping Centre, 23 Yuk Wah Street ALC Ap Lei Chau PO Shop 13-16, G/F, Lei Ning House, Ap Lei Chau Estate WTS Wong Tai Sin PO Shop No. 2, G/F, Lung Lok House, Lower Wong Tai Sin Estate CBP Cyberport PO Shops 5-8, Level 1, The Annex, Cyberport, 100 Cyberport Road YTG Yau Tong PO Unit 14, G/F, Wing Tong House, Yau Tong Estate CHW Chai Wan PO G/F, Administration Building, Yue Wan Estate, Chai Wan Road YYT Yau Yat Tsuen PO G/F, 11A Fa Po Street, Yau Yat Tsuen CWB Causeway Bay PO Shops 1015-1018, 10/F, Windsor House, 311 Gloucester Road New Territories GLR Gloucester Road PO 1/F, Revenue Tower, 5 Gloucester Road, Wan Chai BUT Butterfly PO Shop Nos. R146 and R147, G/F, Tip Sum House, Butterfly Estate GPO General PO 2 Connaught Place, Central CFT Cheung Fat PO Units 113-114, G/F, Chun Fat House, Cheung Fat Estate HAV Happy Valley PO G/F, 14-16 Sing Woo Road, Happy Valley CMG Choi Ming PO Shop No. 240, G/F, Choi Ming Shopping Centre Extension, Choi Ming Court HEN Hennessy Road PO Shop 105, 1/F, One Hennessy, 1 Hennessy Road, Wan Chai COS City One Shatin PO G/F, G1-A Ngan Shing Street, Fortune City One HFC Heng Fa Chuen PO G/F, West Car Park Block, Heng Fa Chuen FNG Fanling PO G/F, North District Government Offices Building, 3 Pik Fung Road HFS Hing Fat Street PO G/F, Causeway Bay Kaifong Welfare Association Building, 30 Hing Fat Street FOT Fo Tan PO G/F, Sha Tin Galleria, 18-24 Shan Mei Street HMS Hing Man Street PO G/F, Shop 1, Wing Hing Court, 50-52 Hing Man Street, Sai Wan Ho FPK Fairview Park PO Shop 3, G/F, Block D, Town Centre, Fairview Park KNG King's Road PO Shops 204-205A and 208-210, 2/F., Olympia Plaza, 255 King's Road FTI Fu Tai PO Shop 210B, 2/F, Fu Tai Shopping Centre, Fu Tai Estate KTN Kennedy Town PO G/F, Kennedy Town Community Complex, 12 Rock Hill Street FUS Fu Shin PO 1/F, Shop No. F106, Fu Shin Shopping Centre, Fu Shin Estate LTG Lei Tung PO Shop 303, 305&307, L3, Lei Tung Commercial Centre Phase 1, Lei Tung Estate HGN Heng On PO Shop No. 232, Level 2, Heng On Commercial Centre, Heng On Estate MHL Morrison Hill PO G/F, 28 Oi Kwan Road, Wan Chai HNK Hin Keng PO No. 202, 1/F, Wing A, Hin Keng Shopping Centre, Hin Keng Estate PEK Peak PO Shop P116, P1, the Peak Tower, 128 Peak Road KMT Kam Tin PO Kam Tin Main Road, Kam Tin PFL Pok Fu Lam PO G/F, Block H-19, Fu Wing Yuen, Chi Fu Fa Yuen KSG Kwai Shing PO Unit No. 1A, G/F, Block 7, Kwai Shing West Estate PKR Perkins Road PO G/F, 5 Perkins Road, Jardine's Lookout KTI Kam Tai PO Shop No. 3, G/F., Kam Tai Shopping Centre, Kam Tai Court RPB Repulse Bay PO Unit C, G/F, 2H South Bay Road KWC Kwai Chung PO Unit No. 11, G/F, Chau Kwai House, Kwai Chung Estate SKN Shau Kei Wan PO G/F, Perfect Mount Gardens, 1 Po Man Street KWF Kwai Fong PO Shop No. 4-10, G/F, Kwai Kin House, Kwai Fong Estate SSW Siu Sai Wan PO Unit 1-2, G/F, Sui Yick House, Siu Sai Wan Estate KWY Kwong Yuen PO Shop No. 4, Block 4, Kwong Yuen Shopping Centre, Kwong Yuen Estate STY Stanley PO 2 Wong Ma Kok Road LEN Lee On PO Shop No. 104, Level LG1, Lee On Shopping Centre, Lee On Estate SWN Sheung Wan PO 1/F, West Exchange Tower, 322-324 Des Voeux Road LGK Leung King PO Shop No. L105, Level 1, Leung King Plaza, Leung King Estate SYP Sai Ying Pun PO 27 Pok Fu Lam Road LKG Lai King PO G/F, Lok King House, Lai King Estate TKS Tai Koo Shing PO Shop G1020-1022, G/F, Kam Sing Mansion, 1-3 Tai Fung Avenue LMS Lei Muk Shue PO G/F, Wing B, Chung Shue House, Lei Muk Shue (II) Estate TTM Tsat Tsz Mui PO Shops 1, 6, 7&11, G/F, Block C, Model Housing Estate, 770 King's Road MEL Mei Lam PO Shop No. 35-37, 1/F, Mei Lam Commercial Centre, Mei Lam Estate WCH Wan Chai PO 2/F Wu Chung House, 197-213 Queen's Road East MOS Ma On Shan PO Shop G2, Level G, MOSTown, 18 On Luk Street WFU Wah Fu PO 423-424, Wah Chun House, Wah Fu (I) Estate PLM Po Lam PO Unit 2, G/F, Restaurant Block, Po Lam Estate WYN Wyndham Street PO G/F, Hoseinee House, 69 Wyndham Street SCL Sha Tin Central PO 1/F Sha Tin Government Offices, 1 Sheung Wo Che Road
Kowloon SHK Sha Kok PO Shop 245, 2/F, Sha Kok Shopping Centre, Sha Kok Estate CHC Choi Hung Chuen PO 9B, G/F, Kam Wah House, Choi Hung Estate SHT Sheung Tak PO Shop 229, 2/F, TKO Spot, Sheung Tak Estate CKY Chuk Yuen PO Shop No. S10, Chuk Yuen Plaza, Chuk Yuen (South) Estate SKG Sai Kung PO G/F, Sai Kung Government Offices, 34 Chan Man Street CNR Concorde Road PO G/F, Trade and Industry Tower, 3 Concorde Road, Kai Tak SLI Shek Lei PO Shop 231, 2/F Shek Lei Shopping Centre Phase II CSW Cheung Sha Wan PO G/F, China Shipbuilding Tower, 646 Cheung Sha Wan Road SNC Sun Chui PO Shop No. 8, G/F, Sun Chui Shopping Centre, Sun Chui Estate FSN Fu Shan PO 1A, G/F, Fu Shun House, Fu Shan Estate SNT San Tin PO 1A Castle Peak Road, San Tin GAV Gillies Avenue PO G/F, 140 Gillies Avenue North, Hung Hom STK Sha Tau Kok PO Sha Tau Kok Rural Building, 1 Shun Lung Street GVR Granville Road PO Shop G3, G/F, Albion Plaza, 2-6 Granville Road SWH Shek Wu Hui PO 112-116 San Fung Avenue, Shek Wu Hui HHB Hung Hom Bay PO G/F, Block 14, Cherry Mansions, Whampoa Garden SWK Shek Wai Kok PO Unit Nos. 8 & 9, G/F, Shek Fong House, Shek Wai Kok Estate HMT Ho Man Tin PO Unit 2, G/F, Tim Man House, Ho Man Tin Estate TCL Tuen Mun Central
PO Podium Level, Tuen Mun Government Offices, 1 Tuen Hi Road
KBY Kowloon Bay PO Shop 1 & 3, 1/F, Tower 1, Enterprise Square One, 9 Sheung Yuet Road THG Tai Hing PO Shop 63, G/F, Tai Hing Commercial Centre, Tai Hing Estate KCL Kowloon Central PO G/F, Kowloon Government Offices, 405 Nathan Road, Yau Ma Tei TKO Tseung Kwan O PO Shop 14C, G/F, Ming Tak Shopping Centre, Ming Tak Estate KCY Kowloon City PO G/F, 28 Lung Kong Road, Kowloon City TNY Tin Yiu PO Shop L122,1/F, Tin Yiu Plaza, Tin Yiu Estate KEA Kowloon East PO G/F, Kowloon East Government Offices Building, 12 Lei Yue Mun Road TPO Tai Po PO G/F, Tai Po Government Offices, 1 Ting Kok Road KTG Kwun Tong PO Unit A & Unit B, G/F, 52 Hung To Road TSW Tsuen Wan PO 1/F, Tsuen Wan Government Offices, 38 Sai Lau Kok Road
KWW Kwong Wa Street PO Shop No. 11-14, G/F, Kwong Fai Mansion, 3-13 Kwong Wa Street TWW Tsuen Wan West PO G/F, Bayview Garden, 633 Castle Peak Road LFU Lok Fu PO Shop No. 3152, 3rd floor, Lok Fu Place, Lok Fu Estate TYI Tsing Yi PO Shop 1, G/F, Hong Kwai House, Cheung Hong Estate LKK Lai Kok PO Shops 105 & 106, 1st level, Lai Huen House, Lai Kok Estate TYT Tin Yuet PO Unit 1, G/F, Wing B, Yuet Tai House, Tin Yuet Estate LMT Lam Tin PO Shop No.115, Kai Tin Shopping Centre, Kai Tin Estate WMG Wah Ming PO Shop No. G43, G/F, Wah Ming Shopping Centre, Wah Ming Estate MGK Mong Kok PO 1/F, Mongkok Exchange, 37 Bute Street, Mong Kok WOC Wo Che PO Shop No. 313, 3/F, Wo Che Plaza, Wo Che Estate MSC Mei Foo Sun Chuen
PO Shop No. 115, Ground Level, West Rail Mei Foo Station WTT Wan Tau Tong PO Shop No. 28, G/F, Wan Tau Tong Shopping Centre, Wan Tau Tong Estate
NCW Ngau Chi Wan PO Shop No. A215, G/F, Choi Wan Shopping Centre, Phase IIB, Choi Wan (I) Estate YLG Yuen Long PO Shop B, G/F, 8 Yuen Long Pau Cheung Square NTK Ngau Tau Kok PO Shop No. 13, G/F, On Kay Commercial Centre, On Kay Court YUR Yeung Uk Road PO Shop 15, 1/F, Indihome, 138 Yeung Uk Road OIM Oi Man PO Shop No. G13, G/F, Oi Man Plaza, Oi Man Estate Outlying Islands SHU Shun Lee PO Shops 17-18, G/F, Lee Foo House, Shun Lee Estate APT Airport PO No. 082, Departures Check-in Hall, Level 7, Terminal 1 SKM Shek Kip Mei PO Shop 132 & 134, Ground Floor, Block 19, Shek Kip Mei Estate
(Please use entrance at Woh Chai Street) CCU Cheung Chau PO G/F, Cheung Chau Municipal Services Building, 2 Tai Hing Tai Road
SMP Sau Mau Ping PO Shop 25, G/F, Sau Mau Ping Shopping Centre, Sau Mau Ping Estate DBY Discovery Bay PO Shop 12A, G/F, Block C, Discovery Bay Plaza, Discovery Bay SSP Sham Shui Po PO G/F, 55 Un Chau Street LMA Lamma PO G/F, 2 Yung Shue Wan Main Street SUK So Uk PO Shop No.2, Free Standing Block No.2 (Near Cherry House), So Uk Estate MWO Mui Wo PO G/F, Mui Wo Government Offices Building, 2 Ngan Kwong Wan Road TKT Tai Kok Tsui PO G/F, 67 Anchor Street, Tai Kok Tsui PCH Peng Chau PO G/F, Peng Chau Government Building, 2A Wing On Side Street TKW To Kwa Wan PO Arcade Shop D, G/F, Hang Chien Court, Wyler Garden TAO Tai O PO G/F, Tai O Government Building, 102 Shek Tsai Po Street, Tai O TST Tsim Sha Tsui PO G/F & 1/F, Hermes House, 10 Middle Road TCG Tung Chung PO G/F, 6 Mei Tung Street, Tung Chung
HKSAR Government CPS-2(E) (Page 1 of 3)
Cash Payout Scheme Registration Form (For Cheque Payment to Registrant)
Notes: 1. Please read the Guidance Notes overleaf before completing this registration form (“Form”). 2. Please use a non-erasable black or dark blue ball pen to fill in this Form in BLOCK letters. For
any amendments, please initial next to them, and do not use correction fluid or correction tape.
Reference No. (For Hongkong Post Use Only)
2
Part 1 Personal Particulars of Registrant
HK Permanent Identity Card No. ( ) Local Contact Telephone No. (local SMS-enabled mobile phone no. preferred)
English Name as shown on the HK Permanent Identity Card Local Correspondence Address
Chinese Name (if applicable)
# 1. HK / 2. KLN / 3. NT
Part 2 Cheque Collection Location (Please refer to the post office codes and addresses on page 3.) I shall collect the cheque at the post office specified below.
Post Office Code ( )
Part 3 Declaration and Undertaking of Registrant
1. 2. 3. 4. 5. 6.
I, the undersigned, declare that I am the holder of Hong Kong Permanent Identity Card (“HKPIC”) number as specified in Part 1 of this Form. I have read and fully understand the content of the following “Personal Information Collection Statement”. Personal Information Collection Statement How your Data will be used Your information and personal data provided in this Form and other information that may be provided by you in relation to the Cash Payout Scheme (collectively referred to as “the Data”) will be used for the purpose of: (i) effecting cash handouts under the Cash Payout Scheme; and (ii) effecting cash/non-cash handouts/refunds (if any) under schemes administered by the Hong Kong Special Administrative Region Government (“the
Government”) in future that are aimed at, amongst other things, encouraging local consumption, relieving people’s financial burden, and/or returning wealth to the people (“Other Schemes”).
The purposes mentioned above are collectively referred to as “Purposes”; and the Cash Payout Scheme and Other Schemes are collectively referred to as “Such Schemes”. The Data will be used: (i) to process your registration (if applicable) of and to administer the handouts/refunds under Such Schemes (including but not limited to the process(es)
referred to in (ii) and (iii) below); (ii) to communicate with you on matters relating to the Purposes, including but not limited to sending SMS notifications, issuing written notifications
and effecting handouts/refunds to you; (iii) to conduct matching between the Data and the personal data held by the Government to check your eligibility under Such Schemes; (iv) for statistics purposes on the condition that the resulting statistics will not be made available in a form which will identify individual registrants (i.e.
the data subjects); and (v) for any other purposes as may be required, authorised or permitted by law. It is voluntary for you to supply the data required by this Form. If you fail to supply any of the data required by this Form, your registration (if any) under Such Schemes may not be processed or you may not receive the handouts/refunds under Such Schemes. Transfer and/or Disclosure of the Data (i) The Data will be transferred to and used by relevant bureaux and departments of the Government including but not limited to the Treasury, Office of
the Government Chief Information Officer, Immigration Department, Hongkong Post and Financial Services and the Treasury Bureau (“the relevant bureaux and departments”), as well as their agents/contractors operating in or outside Hong Kong, for the Purposes; and
(ii) The Data will be disclosed to agencies which are authorised to receive information relating to law enforcement, prosecution or review of the decisions regarding your eligibility under Such Schemes.
Data Access Requests (i) You have the right to request for access to and correction of the personal data provided in this Form under the Personal Data (Privacy) Ordinance
(Cap 486) (the “Ordinance”), subject to any relevant exemption(s); (ii) Please note that a data access request shall or may be refused in the circumstances specified in section 20 of the Ordinance; and (iii) Your requests or enquiries should be made by any one of the following means: (a) by email to [email protected]; (b) by fax to 3106 0701;
or (c) by post to GPO Box 180000, Hong Kong. I hereby consent to the use of the Data for any checking and/or investigation relating to my registration (if any) and receipt of handouts/refunds under Such Schemes to be carried out by the relevant bureaux and departments, including their agents/contractors, and that they may disclose the Data to any other parties if the disclosure is necessary for such checking and/or investigation. I also consent to the matching of the Data with my personal data held by the relevant bureaux and departments and/or their agents/contractors, including but not limited to my personal data kept under the Registration of Persons Ordinance (Cap 177) by the Immigration Department, in relation to my registration (if any) and receipt of handouts/refunds under Such Schemes. I understand that the matching procedure is conducted for ascertaining whether I am eligible under Such Schemes or not, and therefore I will not receive handouts/refunds under Such Schemes in case I am ineligible. I agree and undertake to notify the Government forthwith of any overpayment or any payment or refund by mistake to me under Such Schemes and to repay or refund the same to the Government. I declare that the information and personal data provided in this Form is true and correct. I understand that if I knowingly or wilfully make any false statement, withhold any information, or otherwise mislead the Government for the purpose of obtaining handouts/refunds under Such Schemes, I will be liable for prosecution.
Signature of Registrant
Date
#Delete whichever is inappropriate.
Please complete and return this Form by putting it in the Cash Payout Scheme drop-box at any post office or sending it by post to “GPO Box 182020, Hong Kong”. No postage stamp is necessary if posted in Hong Kong.
A 0 0 0 0 0 0 0 x x x x x x x xS U N G Y I N K A M
F L A T A 1 2 F L O O R
1 0 0 0 0 H E N N E S S Y R O A D
W A N C H A I
宋彥金
SAMPLE
H E N
HKSAR Government CPS-2(E) (Page 2 of 3)
Cash Payout Scheme Guidance Notes 1. Eligibility Criteria
The registrant should fulfil the eligibility criteria of the Cash Payout Scheme, i.e. on or before 31 March 2021, the registrant is aged 18 or above and is a Hong Kong permanent resident holding either a valid Hong Kong Permanent Identity Card or a Certificate of Exemption. For details of the eligibility criteria of the Cash Payout Scheme, please visit the website of the Scheme (www.cashpayout.gov.hk) or call the Enquiry Hotline 182020.
2. Registration (i) The registrant must provide his/her signature in this Form. Failure to provide the required information and the signature of the registrant
may result in non-processing of this Form. The registrant should provide a SMS-enabled local mobile phone number (if any) and local correspondence address for receiving notification(s) from Hongkong Post in relation to the registration. The registrant is advised to make reference to the sample below.
(ii) The duly completed Form should be submitted on or before 31 December 2021:
- in an envelope addressed to “GPO Box 182020, Hong Kong”. It is not necessary to affix stamps on the envelope if posted in Hong Kong (the postage will be borne by the Government).
(iii) Registrants may also register on-line via the website of Hongkong Post. (iv) Each registrant should submit only ONE registration under the Cash Payout Scheme and ensure accuracy of the information provided.
Duplicate registrations will not be processed. This Form, once submitted, cannot be withdrawn except with valid reasons. Subsequent amendment of information therein will delay the processing of registration and payment.
(v) Registrants will receive an acknowledgement of registration from Hongkong Post by SMS or post upon receipt of their registrations. In case it is necessary to clarify any information provided in this Form, Hongkong Post may contact the registrants by a designated phone number 2908 0070 or by post. Where necessary, e.g. in the event of inaccurate or incomplete information, the registrant may be requested to make a re-submission.
(vi) Registrants with their registration completed and eligibility confirmed will receive a notification by SMS or post informing them to collect the cheque. In case the registration is not successful, a notification will be sent to the registrant by SMS or post.
(vii) The default Post Office Code for cheque collection location is “GPO” if the registrant has not indicated any post office code, or he/she has indicated an incorrect Post Office Code in Part 2 (Cheque Collection Location) but the staff of Hongkong Post cannot successfully contact the registrant for clarification.
(viii) If the registrant fails to collect the cheque within 6 months from its date, a new cheque (“re-issued cheque”) will be issued automatically and be available for collection at the same post office. If the registrant still fails to collect the re-issued cheque within 6 months from its date, or despite having collected it, fails to encash it or deposit it with a bank before it becomes stale, he/she will be deemed to have forfeited his/her right to the cash handout under the Cash Payout Scheme.
3. Enquiries For enquiries, please call the Enquiry Hotline 182020. For Post Office codes and addresses, please refer to the list on page 3 or the website of Hongkong Post (www.hongkongpost.hk).
4. Prevention of Telephone Deception (i) Under no circumstances will the staff of Hongkong Post request for any personal information (i.e. address, Hong Kong Permanent Identity
Card number of the registrant) over the phone. (ii) If any member of the public is in doubt about the authenticity of a call allegedly from Hongkong Post and would like to seek clarifications,
please call the Hongkong Post Enquiry Hotline at 2921 2222.
- through the Cash Payout Scheme drop-box at any post office; or
HKSAR Government CPS-2(E) (Page 3 of 3)
List of Post Office (PO) Codes and Addresses PO Code PO Name PO Address PO Code PO Name PO Address
Hong Kong Kowloon ABD Aberdeen PO G/F, Kam Fung Building, 171 Aberdeen Main Road TWS Tsz Wan Shan PO Shop 330, 3/F, Tsz Wan Shan Shopping Centre, 23 Yuk Wah Street ALC Ap Lei Chau PO Shop 13-16, G/F, Lei Ning House, Ap Lei Chau Estate WTS Wong Tai Sin PO Shop No. 2, G/F, Lung Lok House, Lower Wong Tai Sin Estate CBP Cyberport PO Shops 5-8, Level 1, The Annex, Cyberport, 100 Cyberport Road YTG Yau Tong PO Unit 14, G/F, Wing Tong House, Yau Tong Estate CHW Chai Wan PO G/F, Administration Building, Yue Wan Estate, Chai Wan Road YYT Yau Yat Tsuen PO G/F, 11A Fa Po Street, Yau Yat Tsuen CWB Causeway Bay PO Shops 1015-1018, 10/F, Windsor House, 311 Gloucester Road New Territories GLR Gloucester Road PO 1/F, Revenue Tower, 5 Gloucester Road, Wan Chai BUT Butterfly PO Shop Nos. R146 and R147, G/F, Tip Sum House, Butterfly Estate GPO General PO 2 Connaught Place, Central CFT Cheung Fat PO Units 113-114, G/F, Chun Fat House, Cheung Fat Estate HAV Happy Valley PO G/F, 14-16 Sing Woo Road, Happy Valley CMG Choi Ming PO Shop No. 240, G/F, Choi Ming Shopping Centre Extension, Choi Ming Court HEN Hennessy Road PO Shop 105, 1/F, One Hennessy, 1 Hennessy Road, Wan Chai COS City One Shatin PO G/F, G1-A Ngan Shing Street, Fortune City One HFC Heng Fa Chuen PO G/F, West Car Park Block, Heng Fa Chuen FNG Fanling PO G/F, North District Government Offices Building, 3 Pik Fung Road HFS Hing Fat Street PO G/F, Causeway Bay Kaifong Welfare Association Building, 30 Hing Fat Street FOT Fo Tan PO G/F, Sha Tin Galleria, 18-24 Shan Mei Street HMS Hing Man Street PO G/F, Shop 1, Wing Hing Court, 50-52 Hing Man Street, Sai Wan Ho FPK Fairview Park PO Shop 3, G/F, Block D, Town Centre, Fairview Park KNG King's Road PO Shops 204-205A and 208-210, 2/F., Olympia Plaza, 255 King's Road FTI Fu Tai PO Shop 210B, 2/F, Fu Tai Shopping Centre, Fu Tai Estate KTN Kennedy Town PO G/F, Kennedy Town Community Complex, 12 Rock Hill Street FUS Fu Shin PO 1/F, Shop No. F106, Fu Shin Shopping Centre, Fu Shin Estate LTG Lei Tung PO Shop 303, 305&307, L3, Lei Tung Commercial Centre Phase 1, Lei Tung Estate HGN Heng On PO Shop No. 232, Level 2, Heng On Commercial Centre, Heng On Estate MHL Morrison Hill PO G/F, 28 Oi Kwan Road, Wan Chai HNK Hin Keng PO No. 202, 1/F, Wing A, Hin Keng Shopping Centre, Hin Keng Estate PEK Peak PO Shop P116, P1, the Peak Tower, 128 Peak Road KMT Kam Tin PO Kam Tin Main Road, Kam Tin PFL Pok Fu Lam PO G/F, Block H-19, Fu Wing Yuen, Chi Fu Fa Yuen KSG Kwai Shing PO Unit No. 1A, G/F, Block 7, Kwai Shing West Estate PKR Perkins Road PO G/F, 5 Perkins Road, Jardine's Lookout KTI Kam Tai PO Shop No. 3, G/F., Kam Tai Shopping Centre, Kam Tai Court RPB Repulse Bay PO Unit C, G/F, 2H South Bay Road KWC Kwai Chung PO Unit No. 11, G/F, Chau Kwai House, Kwai Chung Estate SKN Shau Kei Wan PO G/F, Perfect Mount Gardens, 1 Po Man Street KWF Kwai Fong PO Shop No. 4-10, G/F, Kwai Kin House, Kwai Fong Estate SSW Siu Sai Wan PO Unit 1-2, G/F, Sui Yick House, Siu Sai Wan Estate KWY Kwong Yuen PO Shop No. 4, Block 4, Kwong Yuen Shopping Centre, Kwong Yuen Estate STY Stanley PO 2 Wong Ma Kok Road LEN Lee On PO Shop No. 104, Level LG1, Lee On Shopping Centre, Lee On Estate SWN Sheung Wan PO 1/F, West Exchange Tower, 322-324 Des Voeux Road LGK Leung King PO Shop No. L105, Level 1, Leung King Plaza, Leung King Estate SYP Sai Ying Pun PO 27 Pok Fu Lam Road LKG Lai King PO G/F, Lok King House, Lai King Estate TKS Tai Koo Shing PO Shop G1020-1022, G/F, Kam Sing Mansion, 1-3 Tai Fung Avenue LMS Lei Muk Shue PO G/F, Wing B, Chung Shue House, Lei Muk Shue (II) Estate TTM Tsat Tsz Mui PO Shops 1, 6, 7&11, G/F, Block C, Model Housing Estate, 770 King's Road MEL Mei Lam PO Shop No. 35-37, 1/F, Mei Lam Commercial Centre, Mei Lam Estate WCH Wan Chai PO 2/F Wu Chung House, 197-213 Queen's Road East MOS Ma On Shan PO Shop G2, Level G, MOSTown, 18 On Luk Street WFU Wah Fu PO 423-424, Wah Chun House, Wah Fu (I) Estate PLM Po Lam PO Unit 2, G/F, Restaurant Block, Po Lam Estate WYN Wyndham Street PO G/F, Hoseinee House, 69 Wyndham Street SCL Sha Tin Central PO 1/F Sha Tin Government Offices, 1 Sheung Wo Che Road
Kowloon SHK Sha Kok PO Shop 245, 2/F, Sha Kok Shopping Centre, Sha Kok Estate CHC Choi Hung Chuen PO 9B, G/F, Kam Wah House, Choi Hung Estate SHT Sheung Tak PO Shop 229, 2/F, TKO Spot, Sheung Tak Estate CKY Chuk Yuen PO Shop No. S10, Chuk Yuen Plaza, Chuk Yuen (South) Estate SKG Sai Kung PO G/F, Sai Kung Government Offices, 34 Chan Man Street CNR Concorde Road PO G/F, Trade and Industry Tower, 3 Concorde Road, Kai Tak SLI Shek Lei PO Shop 231, 2/F Shek Lei Shopping Centre Phase II CSW Cheung Sha Wan PO G/F, China Shipbuilding Tower, 646 Cheung Sha Wan Road SNC Sun Chui PO Shop No. 8, G/F, Sun Chui Shopping Centre, Sun Chui Estate FSN Fu Shan PO 1A, G/F, Fu Shun House, Fu Shan Estate SNT San Tin PO 1A Castle Peak Road, San Tin GAV Gillies Avenue PO G/F, 140 Gillies Avenue North, Hung Hom STK Sha Tau Kok PO Sha Tau Kok Rural Building, 1 Shun Lung Street GVR Granville Road PO Shop G3, G/F, Albion Plaza, 2-6 Granville Road SWH Shek Wu Hui PO 112-116 San Fung Avenue, Shek Wu Hui HHB Hung Hom Bay PO G/F, Block 14, Cherry Mansions, Whampoa Garden SWK Shek Wai Kok PO Unit Nos. 8 & 9, G/F, Shek Fong House, Shek Wai Kok Estate HMT Ho Man Tin PO Unit 2, G/F, Tim Man House, Ho Man Tin Estate TCL Tuen Mun Central
PO Podium Level, Tuen Mun Government Offices, 1 Tuen Hi Road
KBY Kowloon Bay PO Shop 1 & 3, 1/F, Tower 1, Enterprise Square One, 9 Sheung Yuet Road THG Tai Hing PO Shop 63, G/F, Tai Hing Commercial Centre, Tai Hing Estate KCL Kowloon Central PO G/F, Kowloon Government Offices, 405 Nathan Road, Yau Ma Tei TKO Tseung Kwan O PO Shop 14C, G/F, Ming Tak Shopping Centre, Ming Tak Estate KCY Kowloon City PO G/F, 28 Lung Kong Road, Kowloon City TNY Tin Yiu PO Shop L122,1/F, Tin Yiu Plaza, Tin Yiu Estate KEA Kowloon East PO G/F, Kowloon East Government Offices Building, 12 Lei Yue Mun Road TPO Tai Po PO G/F, Tai Po Government Offices, 1 Ting Kok Road KTG Kwun Tong PO Unit A & Unit B, G/F, 52 Hung To Road TSW Tsuen Wan PO 1/F, Tsuen Wan Government Offices, 38 Sai Lau Kok Road
KWW Kwong Wa Street PO Shop No. 11-14, G/F, Kwong Fai Mansion, 3-13 Kwong Wa Street TWW Tsuen Wan West PO G/F, Bayview Garden, 633 Castle Peak Road LFU Lok Fu PO Shop No. 3152, 3rd floor, Lok Fu Place, Lok Fu Estate TYI Tsing Yi PO Shop 1, G/F, Hong Kwai House, Cheung Hong Estate LKK Lai Kok PO Shops 105 & 106, 1st level, Lai Huen House, Lai Kok Estate TYT Tin Yuet PO Unit 1, G/F, Wing B, Yuet Tai House, Tin Yuet Estate LMT Lam Tin PO Shop No.115, Kai Tin Shopping Centre, Kai Tin Estate WMG Wah Ming PO Shop No. G43, G/F, Wah Ming Shopping Centre, Wah Ming Estate MGK Mong Kok PO 1/F, Mongkok Exchange, 37 Bute Street, Mong Kok WOC Wo Che PO Shop No. 313, 3/F, Wo Che Plaza, Wo Che Estate MSC Mei Foo Sun Chuen
PO Shop No. 115, Ground Level, West Rail Mei Foo Station WTT Wan Tau Tong PO Shop No. 28, G/F, Wan Tau Tong Shopping Centre, Wan Tau Tong Estate
NCW Ngau Chi Wan PO Shop No. A215, G/F, Choi Wan Shopping Centre, Phase IIB, Choi Wan (I) Estate YLG Yuen Long PO Shop B, G/F, 8 Yuen Long Pau Cheung Square NTK Ngau Tau Kok PO Shop No. 13, G/F, On Kay Commercial Centre, On Kay Court YUR Yeung Uk Road PO Shop 15, 1/F, Indihome, 138 Yeung Uk Road OIM Oi Man PO Shop No. G13, G/F, Oi Man Plaza, Oi Man Estate Outlying Islands SHU Shun Lee PO Shops 17-18, G/F, Lee Foo House, Shun Lee Estate APT Airport PO No. 082, Departures Check-in Hall, Level 7, Terminal 1 SKM Shek Kip Mei PO Shop 132 & 134, Ground Floor, Block 19, Shek Kip Mei Estate
(Please use entrance at Woh Chai Street) CCU Cheung Chau PO G/F, Cheung Chau Municipal Services Building, 2 Tai Hing Tai Road
SMP Sau Mau Ping PO Shop 25, G/F, Sau Mau Ping Shopping Centre, Sau Mau Ping Estate DBY Discovery Bay PO Shop 12A, G/F, Block C, Discovery Bay Plaza, Discovery Bay SSP Sham Shui Po PO G/F, 55 Un Chau Street LMA Lamma PO G/F, 2 Yung Shue Wan Main Street SUK So Uk PO Shop No.2, Free Standing Block No.2 (Near Cherry House), So Uk Estate MWO Mui Wo PO G/F, Mui Wo Government Offices Building, 2 Ngan Kwong Wan Road TKT Tai Kok Tsui PO G/F, 67 Anchor Street, Tai Kok Tsui PCH Peng Chau PO G/F, Peng Chau Government Building, 2A Wing On Side Street TKW To Kwa Wan PO Arcade Shop D, G/F, Hang Chien Court, Wyler Garden TAO Tai O PO G/F, Tai O Government Building, 102 Shek Tsai Po Street, Tai O TST Tsim Sha Tsui PO G/F & 1/F, Hermes House, 10 Middle Road TCG Tung Chung PO G/F, 6 Mei Tung Street, Tung Chung
