Annex E to IV.3
Version 9.2 – November 2023
FORM MPF(S) - C(SD)
MANDATORY PROVIDENT FUND SCHEMES ORDINANCE (CAP 485)
(the Ordinance)
STATUTORY DECLARATION ON CESSATION OF EMPLOYMENT
I, ___________________________________ [name of the employee], Hong Kong Identity
Card/Passport*
#
No.: ____________________ of __________________________________
_____________________________________________________ [address of the employee],
solemnly and sincerely declare that I have ceased employment with my former employer,
___________________________________________________________ [name of employer]
on ______________________ [dd/mm/yyyy].
And I make this solemn declaration conscientiously believing the same to be true and by virtue
of the Oaths and Declarations Ordinance (Cap 11).
_____________________________________
[Signature of the employee]
Declared at ___________________________, Hong Kong this ________ day of ________.
Before me,
Signature and company chop (if applicable) of
the person administering the statutory declaration: _________________________________
Name in block letters: ____________________________
Designation: ____________________________________
* Delete whichever is not applicable
#
The employee should give the passport number ONLY when he/she does NOT possess a Hong Kong
Identity Card
Warning: Under section 43E of the Ordinance, a person who, in any document given to the
Mandatory Provident Fund Schemes Authority or an approved trustee, knowingly or
recklessly makes a statement which is false or misleading in a material respect commits
an offence and is liable to a maximum penalty of a $100,000 fine and one year’s
imprisonment on the first conviction and a $200,000 fine and two years’ imprisonment
on each subsequent conviction. A person who knowingly and wilfully makes a
statutory declaration false in a material particular also commits an offence under section
36 of the Crimes Ordinance (Cap 200) and is liable on conviction to imprisonment for
two years and to a fine.
