I am above the age of 50 but below 55 and have not been employed in Singapore during the preceding 2 years.
*I have / the member has been examined and certified by ______________________________(Name of
Registered Medical Practitioner) to be *physically / mentally incapacitated from ever continuing in any employment.
2. In accordance with section 15 of the Central Provident Fund Act and Central Provident Fund (Investment Schemes)
Regulations, I hereby apply to withdraw all the monies standing to *my / the members credit in (a) the Central Provident
Fund, (b) *my / the members CPF Investment Account, if any, and (c) all *my / the members investments under the
CPF Investment Scheme Ordinary Account and CPF Investment Scheme - Special Account, if any.
3. In accordance with section 27K(5) of the CPF Act, I hereby apply to be excluded from CPF LIFE if I am placed on CPF
LIFE under section 27K(2), such that the CPF LIFE policy would not be issued to me automatically. (Note: If you have a
CPF LIFE policy, you need to apply to terminate your CPF LIFE policy. Please refer to page 4 for more information.)
4. I understand that:
(i) Upon the approval of this application by the CPF Board (the Board)
all the monies in *my / the members CPF Investment Account (if any), and all *my / the members investments
under the CPF Investment Schemes (if any), will be automatically transferred to *me / the member by *my / the
members agent bank and / or product providers; and they will no longer be protected from any claims by *my /
the members creditors and / or the Official Assignee; and
CPF refunds will not be required to be made to my CPF account for CPF monies withdrawn for my existing
property (properties), including the accrued interest when I dispose of them. I will be responsible for informing
HDB and/or my lawyers on the above if I have an ongoing sale transaction.
(ii) The Board may refund any unused MediShield Life premiums to *me / the member (by supplementary payment) at a
later date if the Board is notified by *me / the member or a relevant authority to terminate *my / the members
MediShield Life cover later than this present application.
5. I further give my consent to the Board to refer this application at any time and without notice and liability to *me / the
member, and disclose any information relating to *me / the member in the Boards possession (including but not limited
to *my / the members employment and medical information) to *my / the members Dependants Protection Scheme
(DPS) insurer (the Insurer) for the purpose of making a claim under DPS (if any) or to other insurers under any other
insurance scheme(s) referred to in the CPF Act which *I / the member may be insured under.
6. I authorise the Board to obtain verification of information relating to me and to my bank account from the bank, and the
bank to disclose any information whatsoever relating to me and to the account for the purpose of account validation. My
authorisation here shall survive the termination of any of the account with the bank and may be relied on and enforced
as fully and effectively by the bank as if it is addressed to the bank.
* Delete whichever is inapplicable
^ All correspondence will be sent to the address as shown on your Malaysian Identity Card
(05/2016) Page 1 of 4
PART 4 DISCOUNTED SINGTEL SHARES (Please complete this portion if applicable)
I hereby apply for the withdrawal of my discounted Singtel shares. I authorise the CPF Board to transfer all my
discounted Singtel shares to my *individual / joint Central Depository Pte Limited (CDP) Securities Account** as
follows:
1 6 8 1
My joint CDP Securities Account (applicable only if the CDP account indicated above is a joint account) is held with:
_______________________________________________________________________________________________
*Name & NRIC Number (for Singapore Citizen & Permanent Resident) / Name & Passport Number (for foreigner)
I agree to pay the CDP transfer fee of $10.70 (inclusive of 7% GST) to CPF Board by (please tick only one box):
D-PAY at any AXS station; eNETS through the CPF website under E-Services (e-Cashier); or
Cheque number ___________ (Name of Bank __________________) made payable to CPF Board.
I understand that this application is irreversible and that once my discounted Singtel shares are transferred to me,
they will no longer be protected from any claims by my creditors and/or the Official Assignee.
PART 5 BANK DETAILS OF APPLICANT For Banks Certification Only
(i) Bank Account Number : ____________________________________ The Bank hereby certifies that the bank
(Bank account must not be a trust account) account, name and identification / passport
number on this form belong to the applicant.
Name of Bank : ___________________________________________
(ii) To be completed for payment via Telegraphic Transfer only:
...................................................................
______________________________________ _________________ Witness Name, Signature,
Signature / Right Thumbprint Date Official Seal / Stamp & Date
FOR OFFICIAL USE ONLY: RECEIPT OF APPLICATION BY CPF OFFICER
ACKNOWLEDGEMENT OF PAYMENT
DATE RECEIVED
_____________________ _____________________ ____________
Authorised By Date of Processing Code
If your application is not completed at CPF Service Centre, your application and all supporting documents must be
witnessed / certified true by either a Notary Public or an official from the Singapore High Commission / the Embassy
of the Republic of Singapore with his official seal / stamp duly affixed. Certifications by a Justice of Peace or
Commissioner for Oaths are not acceptable.
@You may be required to visit the CPF Service Centre personally if you are unable to provide the requested information for verification.
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MODE OF PAYMENT
1. Payment will be credited into your bank account as stated in this application via:
Please get your bank to certify your bank account information on Part 5 of the form or mail us your original bank
statement for verification. Online bank statements are not acceptable. Bank certification is not required for a
Singapore POSB (excluding DBS), OCBC or UOB bank account maintained under your Singapore NRIC.
The Board has the discretion to decide whether or not to perform verification of information relating to you and
your account with the bank.
2. If the bank account information is not provided or is incomplete, we will issue a cheque in Singapore Dollars to
your address as shown on your Malaysian identity card. (Note: For overseas bank clearance of the cheque, you
will need to bear all bank charges.)
3. If you are below 21 years old, payment will be made to your parent / legal guardian. Please indicate your parent /
legal guardians bank details on Part 5 of the form.
4. Upon approval of your application, your CPF savings or part thereof will be forwarded to Inland Revenue
Authority of Singapore (IRAS) to settle your tax liabilities (if any).
Termination of your annuity policy is subject to terms and conditions and the Boards approval. There will be no
refund if you are covered under the LIFE Income Plan or if your unused annuity premium is zero.
IMPORTANT : An incomplete form and / or incomplete supporting documents will delay the processing of
your application.
CONTACT DETAILS
Website / Email Call Centre
Website: www.cpf.gov.sg 1800-227-1188 (local)
Email : member@cpf.gov.sg 65-6227-1188 (overseas)
[1] The unused annuity premium is the premium paid for the annuity policy less any monthly annuity payment that has been made.
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