聲明及使用及轉移個人資料之同意

DECLARATION AND CONSENT RELATING TO USE ANDTRANSFER OF PERSONAL DATA

本人同意參加本計劃。本人確認本人已獲通知而本人亦同意遵守有關投放項目（退休基金）之管理規章(以及其不時作出之修改)、及有關本計劃之服務協議及設立合同及管理實體於不時就有關投放項目（退休基金）之運作所規定有關行政、管理及投資等細則（若適用）。本人明白有關管理規章、服務協議、設立合同及相關之條款存放在管理實體，即聯豐亨人壽保險股份有限公司的註冊/主要營業地址內供本人隨時查閱。本人亦同意接受有關管理規章（以及其不時作出之修改）、服務協議、設立合同及條款（若適用）之約束。本人確認此申請表上提供的所有資料均為真實及準確無誤。本人並承諾若提供之資料有任何變更，本人將在合理及切實可行之情況下於30日內通知管理實體。

I hereby agree to join the Scheme. I acknowledge that I have been informed and hereby agree to be bound by the terms of the Management Regulation of the Investment Instruments (Pension Funds) (including its amendments), the Service Agreement, and the Establishment Contract relating to the Scheme, the governing rules in respect of the administration, management and investment of the Investment Instruments (Pension Funds) stipulated by the Management Company from time to time (where applicable).  I also understand that copies of the Management Regulation and any amendments or additions from time to time, the Service Agreement, the Establishment Contract and the governing rules etc. are available for my inspection at the registered office/principal place of business of the Management Company, i.e. Luen Fung Hang Life Limited and I hereby agree to comply with and be bound by the Management Regulation, the Service Agreement, the Establishment Contract and the governing rules made (where applicable). I confirm that all the information provided in this application form is true and accurate in all aspects. I further undertake that if there is any change in the information so provided, I shall notify the Management Company of such change within 30 days.

個人資料收集及使用

PERSONAL DATA COLLECTION AND USE

本人確認本人已閱讀及明白聯豐亨人壽保險股份有限公司收集個人資料聲明（「聯豐亨人壽保險收集個人資料聲明」）。本人聲明及同意在本表格所載或管理實體不時以任何方法收集所得、編製或持有關於本人的任何個人資料及其他資料，可根據聯豐亨人壽保險收集個人資料聲明收集及使用。本人知悉及同意就聯豐亨人壽保險收集個人資料聲明所述目的在澳門境內轉移關於本人的個人資料及其他資料或轉移有關資料至澳門境外，及轉移予聯豐亨人壽保險收集個人資料聲明所載的資料接收方。

I confirm that I have read and understood the Luen Fung Hang Life Limited Personal Information Collection Statement (“LFH Life PICS”). I declare and agree that any personal data and other information relating to me contained in this form or collected, obtained, compiled or held by the Management Company by any means from time to time may be collected and utilized in accordance with the LFH Life PICS. I acknowledge and consent to the transfer of personal data and other information relating to me in or outside of Macau for the purposes and to the types of transferee as set out in the LFH Life PICS.

聯豐亨人壽保險收集個人資料聲明的最新版本可於https://lfhlife.com/personal_information_statement下載或向管理實體索取。

The updated version of LFH Life PICS is available for download from https://life.luenfunghang.com/en/personal_information_statement, and is made available upon request.

藉簽署本申請表，本人同意及接納以下：

By signing herein, I agree and consent to the following:

本人提供的個人資料或資訊（不論是否在有關申請表格內所提供）及本人的交易詳情可用作（除其他事項外）處理有關投放項目（退休基金）的申請、處理及管理有關投放項目（退休基金）項下的供款及累算權益的用途、執行指示或回應查詢及向本人提供行政或其他相關服務（包括郵寄報告、通知或簡報）。如管理實體或其他獲委任之服務供應商認為有需要，他們可披露及轉移(在澳門特別行政區及以外地區) 個人資料或資訊予有關人士，包括任何司法管轄區的監管機構和政府機構或機關以及管理實體的任何相關實體，其母公司、聯營公司及其他集團公司（統稱「相關實體」），以便向本人提供有關服務及/或用作與本人的其他個人資料或資訊作核對用途及/或用作直接促銷、推廣、改善或進一步提供服務（包括資料處理）的用途及/或遵守(i) 任何由本地或海外機構或機關不時發出的約束或適用於管理實體、本人及/或其投放項目（退休基金）投資的本地或海外法律、規例、守則或指引，不論是關乎法律、監管、政府、稅務、執法、自律監管、行業或其他方面的；或(ii)任何防止、偵查、制裁或調查罪行、欺詐、洗黑錢、貪污、逃稅、恐怖分子融資及其他不合法的活動的適用法律及規定。如未提供資料可導致管理實體或其他服務供應商不能開立/維持帳戶或向本人提供/繼續提供服務或採取適當的行動或向有關當局申報。本人有權要求查閱及更正任何其個人資料或資訊，或免費地反對使用其個人資料或資訊作直接促銷用途。對查閱或更改資料或索取有關政策、實務上的資料及資料類別之要求，請以書面形式提出並致函管理實體。

Personal data or information provided by me (whether on application forms or not) and details of transactions or dealings by me may be used, among other things, for the purposes of processing the application, administering and managing contributions and accrued benefits under the Investment Instruments (Pension Funds), carrying out instructions or responding to enquiries and providing administrative or other relevant services to me (including mailing of reports, notices or newsletters).  The personal data or information may be disclosed and transferred (in and outside the Macau Special Administrative Region) to such persons as the Management Company or any service provider appointed considers necessary, including regulators and government bodies or authorities in any jurisdiction and any related entities of the Management Company, their parents and affiliated companies and other group companies (collectively, the "Related Entities") for purposes in connection with the services they may provide to me and/or in connection with matching with other personal data or information concerning me and/or for the purpose of direct marketing, promoting, improving and furthering the provision of services (including but not limited to data processing) and/or for complying with (i) any local or foreign laws, rules, codes or guidelines from time to time issued by local or foreign bodies or authorities, whether legal, regulatory, governmental, tax, law enforcement, self-regulatory, industry or others binding or applying to the Management Company, me and/or their investment in the Investment Instruments (Pension Funds); or (ii) any applicable laws and regulations for the purpose of prevention, detection, sanction or investigation of crime, fraud, money laundering, corruption, terrorist financing or other unlawful activities.  Failure to provide information may result in the Management Company or any service provider being unable to open/ maintain an account or provide/ continue to provide services to me or taking appropriate action or reporting to the relevant authorities.  I have right to access and correct any personal data or information or the right to object free of charge their personal data or information being used for direct marketing purposes.  Requests for access to or correction of data or for information regarding policies and practices and data categories should be addressed in writing to the Management Company.

有關「美國人士」之聲明

U.S. PERSON DECLARATION

下列聲明只適用於美國人士（即閣下就上述戊部有關問題的答案為「是」）:

在願受作假證供的懲處下，本人聲明:

(i) 本表格所示的號碼是本人正確的美國稅務編號（Taxpayer Identification Number）；及

(ii) 本人不需要繳納後備預扣稅，因為(a)本人獲豁免不需繳納後備預扣稅，或(b) 本人未有收到美國國家稅務局(「美國國稅局」)通知指因本人未能申報所有利息或股息而需繳交後備預扣稅，或(c) 美國國稅局告知本人不再需要繳交後備預扣稅；及

(iii) 本人是美國公民，或其他美國人士。

The following certification is applicable for a U.S. person (i.e. you have ticked “Yes” in the relevant question of Part E above) only:

Under penalty of perjury, I certify that:

(i) The number shown on this form is my correct U.S. Taxpayer Identification Number; and

(ii) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the U.S. Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the U.S. IRS has notified me that I am no longer subject to backup withholding; and

(iii) I am a U.S. citizen or other U.S. person.

如閣下為美國人士，閣下須同意上述的聲明。美國國稅局並不要求閣下同意其他與避免後備預扣稅無關的條文。

For a U.S. person, you are required to provide the certifications contained in the above paragraph. The U.S. IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholdings.

下列聲明只適用於非美國人士（即閣下就上述戊部分有關問題的答案為「否」）:

在願受作假證供的懲處下，本人聲明已檢查本表格中所填寫的資料，且據本人所知與所信，所填的資料均為真實、正確及完整。此外，本人願受偽證罪的法律制裁下，確認下列事項：

(i) 本人為本表格涉及的所有收入的最終受益人（或授權代表最終受益人簽署的人士），或以本表格聲明本人之FATCA身份；及

(ii) 於甲部所示之人名非為美國人士。

The following certification is applicable for a non-U.S. person (i.e. you have ticked “No” in the relevant question of Part E above) only:

Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:

(i) I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself for FATCA purposes; and

(ii) The person named on Part A is not a U.S. person.

受限於當地適用的法律的情況下，本人同意管理實體可向本地及海外監管機構或稅務機構披露、呈交或提供本人的個人資料以確立本人於任何司法管轄區的稅務責任。

Subject to applicable local laws, I hereby consent for the Management Company to disclose, report, or share my information with local and overseas regulators or tax authorities where necessary to establish my tax liability in any jurisdiction.

因應本地及海外監管機構或稅務機構的要求，本人同意並准許管理實體可按適用的法律、法規和指令在本人戶口中扣留相關所須的款項。

Where required by local or overseas regulators or tax authorities, I consent and agree that the Management Company may withhold from my account(s) such amounts as may be required according to applicable laws, regulations and directives.

本人承諾會與管理實體充分合作，以確保管理實體就處理與本人戶口相關的事宜會符合適用的法律、法規和指令。

I undertake to fully cooperate with the Management Company to ensure it meets its obligations under applicable laws, regulations and directives in connection with my account(s).

此聲明書的英文本與中文譯本如有歧義，概以英文本為準。

In the case of any inconsistency between the English version and the Chinese translation of this form, the English version shall prevail.

本人同意當上述聲明內容有變更時，將於30天內提交更新之聲明書。

I agree that I will submit a new self-certification form within 30 days if any certification made on this form becomes incorrect.