严重急性呼吸系统综合症「综合症」信托基金.PDFVIP

嚴重急性呼吸系統綜合症 「綜合症」信託基金 病故者家屬特別恩恤金 Trust Fund for SARS Special Ex-gratia Relief Payment 1 for Families with Deceased SARS Patients 申請表Ap plic ation Form (A 2) （只適用於病故者遺下的受供養父母項目） （ ） Applicable to the category for surviving dependent parents only 病故者遺下的受供養父母定義 ： 與「綜合症」病故者同住，並且純粹依賴病故者給予財政上支持的父母。其他在這定義外而又值得協助 的個案，會由信託基金委員會酌情考慮。 Definition of surviving dependent parents : Parents who were living with the deceased and had been relying solely on the deceased SARS patient for financial support. Other justified cases will be considered by the Committee on Trust Fund for SARS on a discretionary basis. A 部 病故者個人資料 Section A: Personal Particulars of Deceased Patient 1. 姓名Name :___________________________________________ _______________________ (In English 英文) (In Chinese 中文) 性別／出生日期 2. Sex / Date of birth:___________________ 3. 婚姻狀況Marital Status: _________________ 香港身份證／旅行證件編號* 4. HKIC/Travel document no.*: ________________ 5. 死亡日期 Date of Death : ________________ 6. 死亡證明書編號 Death Certificate No. : _________________________ B 部 申請人 （受益人或受益人授權的任何人士）的個人資料 Section B: Personal Particulars of Applicant (beneficiary or any person authorized by the beneficiary) (受供養父母須各自填寫申請表，如夫婦二人同時提出申請 ，則其中一方無須重新填寫丙部的子女資料 。 Dependent parent is required to complete a separate application form. If the couple submit applications at the same time, one of them is not required to provide the particulars of their childr en a