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MANDATORY PROVIDENT FUND SCHEMES …

FORM INT-5 Version 6 November 2017 Page 1 MANDATORY PROVIDENT fund SCHEMES authority (MPFA) Notification of Principal Intermediary s Withdrawal of Consent to a Subsidiary Intermediary / Application for Approval of Attachment of a Subsidiary Intermediary to a Principal Intermediary (Form to be completed by Principal Intermediary/Corporation seeking to be a Principal Intermediary) (under section 34ZG(2)/section 34V(1) of the MANDATORY PROVIDENT fund SCHEMES Ordinance (Cap 485) (MPFSO)) Name of Principal Intermediary / Corporation Seeking to be a Principal Intermediary*: _____ *(Please delete as appropriate) MPF Registration No. (if any) / Business Registration No. if there is no MPF Registration No.: _____ Section I SUBSIDIARY INTERMEDIARIES (INDIVIDUALS) WHO CEASE TO BE ATTACHED TO THE PRINCIPAL INTERMEDIARY (If there is insufficient space, please continue on a separate sheet.)

FORM INT-5 Version 6 – November 2017 Page 1 MANDATORY PROVIDENT FUND SCHEMES AUTHORITY (MPFA) Notification of Principal Intermediary’s Withdrawal of Consent to a Subsidiary Intermediary /

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