Application Form for claiming Dependent Parent or ... - ç¨ åå±
Application Form for claiming Dependent Parent or ... - ç¨ åå±
Application Form for claiming Dependent Parent or ... - ç¨ åå±
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ʚ໔௭ٝٝ ী<br />
To : The Commissioner of Inland Revenue<br />
ਉཡङᘔٝཡᎣ132<br />
G.P.O. Box 132, Hong Kong.<br />
ᅹҮྚଟ<br />
Faxline No. : 2877 1232<br />
ᖾૂ᎘ ʚ<br />
File No. : _________________________________<br />
ԹᏮᑆӀԦ0ଲӀԦ0<br />
Claim <strong>f<strong>or</strong></strong> <strong>Dependent</strong> <strong>Parent</strong> / Grandparent Allowance <strong>or</strong> Deduction of Elderly Residential Care Expenses<br />
మ၃ིҭװࡃ໔ᜰި֬ை؍ԆଲӀԦ<br />
/ Ᏸ໔֣࣫<br />
Year of Assessment /<br />
ണ1ܹᑆг<br />
Dependant 1<br />
ണ2ܹᑆг<br />
Dependant 2<br />
ണ3ܹᑆг<br />
Dependant 3<br />
(1) ܹᑆгݩռ(ᏮԴԥဒ࿄ጊ)<br />
Full name of dependant ( Please Use Block Letters)<br />
(2) ܹᑆг࠱ਉ۪҉ឞ᎘<br />
Dependant’ s H.K. Identity Card No. ( ) ( ) ( )<br />
(3) ܹᑆгӠԳҲ๚ (ӽ࿄ጊҴ՝җ֣՝); ܹ֕ᑆгևԡ֣࣫҃Ѭ۩<br />
60ဣՍᏮ࿄ጊണ 7 ྈ<br />
Date of birth of dependant (enter month and year only); if the<br />
dependant was less than 60 years old during the year, please also<br />
complete item 7 below<br />
Ҵ<br />
Month<br />
֣<br />
Year<br />
Ҵ<br />
Month<br />
֣<br />
Year<br />
Ҵ<br />
Month<br />
֣<br />
Year<br />
ែ࠱ቖԡгިԡг (4)<br />
Relationship with me / my spouse<br />
ӀԦ<br />
parent<br />
ଲӀԦި<br />
ԆଲӀԦ<br />
grandparent<br />
ӀԦ<br />
parent<br />
ଲӀԦި<br />
ԆଲӀԦ<br />
grandparent<br />
ӀԦ<br />
parent<br />
ଲӀԦި<br />
ԆଲӀԦ<br />
grandparent<br />
請 填 寫 第 (5) 或 第 (6) 其 中 一 項<br />
Complete EITHER Item (5) OR Item (6)<br />
(5)<br />
(i) ӑӠм۩ངԴʖ܀זװᑆгևԡ֣࣫҃එᡛቖԡгյܹ<br />
(࠼6ਡҴʔᏮߍҟװյ)<br />
The dependant resided with me continuously during the year<br />
without paying full cost. (Leave blank if residing period was less<br />
than 6 months)<br />
դ֣ ҟ6ਡҴן<br />
װյ<br />
װյ<br />
<strong>f<strong>or</strong></strong> full <strong>f<strong>or</strong></strong> at least<br />
year 6 months<br />
դ֣ ҟ6ਡҴן<br />
װյ<br />
װյ<br />
<strong>f<strong>or</strong></strong> full<br />
year<br />
<strong>f<strong>or</strong></strong> at least<br />
6 months<br />
դ֣ ҟ6ਡҴן<br />
װյ<br />
װյ<br />
<strong>f<strong>or</strong></strong> full<br />
year<br />
<strong>f<strong>or</strong></strong> at least<br />
6 months<br />
$12,000ߍևԡ֣࣫҃ѲܹᑆгѬҟ࠱ԡгިԡг (ii)<br />
(1998 / 99֣࣫Ӑॡ $1,200) ᕒԳ॒ངʖ࠱<br />
I / my spouse contributed not less than $12,000 in money during<br />
the year ($1,200 pri<strong>or</strong> to year of assessment 1998 / 99) towards<br />
the dependant’ s maintenance.<br />
ढ<br />
Yes<br />
ء<br />
No<br />
ढ<br />
Yes No<br />
ढ ء<br />
Yes<br />
ء<br />
No<br />
(6) (i) ռሠה֜࠱װݺᑆгܹ<br />
Name of the residential care home at which the dependant resided<br />
(ii) ҭི࠱הևԡ֣࣫҃ެҭӑт৪֜࠱ԡгިԡг<br />
ᜰ (Է՚гѓިᒲᇌӑᙫ࠱ፇᜰʔѬᖨৠሩև҃)<br />
Amount of expenses paid by me / my spouse to the above<br />
residential care home during the year (excluding any amount<br />
subsequently reimbursed by any person <strong>or</strong> <strong>or</strong>ganization)<br />
$ $ $<br />
(7) ्ཀʖྞތᑆгևԡֶ֣࣫҃ჷԹङܹ<br />
The dependant was eligible to claim an allowance under the<br />
Government’ s Disability Allowance Scheme during the year.<br />
ढ<br />
Yes<br />
ء<br />
No<br />
ढ<br />
Yes<br />
ء<br />
No<br />
ढ<br />
Yes<br />
ء<br />
No<br />
Ꮾևᐞၝ࠼҃ӣтˈ 9 ˉ<br />
9!in the appropriate box<br />
ᡆ᎔ᆔൽʖفჷ࠱ʔӐтެ෴ެ࠵ฉԡгެߔᘢ<br />
I declare that to the best of my knowledge and belief, all the above statements are true and c<strong>or</strong>rect.<br />
႟<br />
Signature ʚ<br />
Ҳ๚<br />
Dateʚ . Name ʚ<br />
ռݩ<br />
.<br />
.<br />
I.R.ണ687 (6/2002)<br />
I.R.687 (6/2002)
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