PDF《香港特别行政区政府入境事务处》

香港特别行政区政府入境事务处Immigration Department, the Government of the Hong Kong Special Administrative Region 香港特别行政区旅游通行证申请表Application for Hong Kong Special Administrative Region Travel Pass 注意: (i) 填写本表格前请先详细参阅此申请表的「说明事项」 .

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Guidance Notes'

carefully before completing this form. (ii) 领取本表格无须缴费.This form is issued free of charge. (iii) 请用黑色或蓝色笔以正楷填写本表格. Please complete this form in BLOCK letters using black or blue pen. (iv) 请在适当方格内填上「 」号.Please tick as appropriate. (v) * 请将不适用者删去.Please delete where inappropriate. 此栏由办理机关处理FOR OFFICIAL USE ONLY 档案条码 Reference barcode 申请类别简码Nature Code 申请日期Application Date 1. 个人资料 Personal Particulars (请留意「说明事项」第2段Please see paragraph

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Guidance Notes'

) 姓名 (中文) (如有)婚前姓氏 (如适用)Name in Chinese (if any) Maiden surname (if applicable) 姓 (英文) Surname in English 名 (英文) Given names in English 姓(英文) Surname in English 别名 (如有)(中文) Alias (if any) in Chinese 名(英文) Given names in English 性别 Sex 男Male 出生日期 女Female Date of birth 日dd 月mm 年yyyy 出生地点 国籍 Place of birth Nationality 旅行证件类别 签发地点 Travel document type Place of issue 旅行证件号码 Travel document no. 签发日期 Date of issue 日dd 月mm 年yyyy 届满日期 Date of expiry 日dd 月mm 年yyyy 照片 Photograph 请在此处贴上近照一张 Affix one recent photograph here (照片大小为不超过

55 乘45 毫米 及不小於

50 乘40 毫米) (Photograph should not be larger than 55mm x 45mm and not smaller than 50mm x 40mm) 现时住址 Present address 原居地住址 (如与现时住址不同)传真号码 (如有)Address at place of domicile Fax no. (if any) (if different from present address) 联络电话号码 Contact telephone no. 办公室电话号码 Office telephone no. 办公机构/公司名称及地址 传真号码 ( ) Name and address of employing 如有Fax no. (if any) organisation/company 受雇於现时雇主时间 职业 职位 Duration of employment 年月Occupation Post with current employer Year Month 2. 访港纪录 Details of Previous Visits to Hong Kong 过往

12 个月内最后三次的访港日期及目的 (请留意「说明事项」第2段) Last three visits in the past twelve months with dates and purposes (please see paragraph

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Guidance Notes'

) 留港日期 Period of stay 由From 至To 访港目的 Purpose of visit 你是否曾被拒绝签发香港签证或被拒绝入境? Have you ever been refused a visa for or entry to Hong Kong? 是Yes 否No 在本页内所填报的资料均属正确、完备和真实. The information given on this page is correct, complete and true. 如本表格为影印本或从互联网下载,请填写 此栏. Please complete this column if this form is a 日期 photocopy or downloaded copy. Date 申请人签署 Signature of applicant ID

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1 3. 需多次来港原因 Reason for Visiting Hong Kong Frequently 4. 在香港特别行政区谘询人或主要商务联系公司资料 Particulars of Referee or Major Business Contact in the Hong Kong Special Administrative Region 谘询人姓名或公司名称及联络人 Name of referee/Company &

name of contact person 姓名 (中文) (如有)Name in Chinese (if any) 姓 (英文) Surname in English 名 (英文) Given names in English 性别 Sex 男Male 女 香港身份证号码 (如有)Female HK identity card no. (if any) ( ) 商务地址 Business address (请於边界内填写)(please fill in within border) 商业登记证号码 Business registration certificate no. 电邮地址 (如有)E-mail address (if any) 联络电话号码 内线 Contact telephone no. Ext. 传真号码 (如有)Fax no. (if any) 5. 选择领取旅游通行证方法 Means of Collection of Travel Pass 亲身领取 in person 授权他人代领 (请填附录甲)by authorised person (please complete Appendix A) 6. 声明 Declaration 本人知悉:本旅游通行证属於中华人民共和国香港特别行政区政府所有,可由中华人民共和国香港特别行政区入境事务处随时收回及注销. I understand that this Travel Pass is the property of the Government of the Hong Kong Special Administrative Region of the People'

s Republic of China. The Immigration Department of the Hong Kong Special Administrative Region may retrieve and cancel this Travel Pass at any time. 本人,即下开签署人,声明: I, the undersigned, declare that: (i) 就本人所知及确信,这申请表上所填的资料均属正确、完备和真实. The information given in this application form is correct, complete and true to the best of my knowledge and belief. (ii) * 本人以往从未在任何时间申请、持有或被拒发香港特别行政区旅游通行证. * I have not previously applied for, held or been refused a Hong Kong Special Administrative Region Travel Pass. (iii) * 本人上次获发的香港特别行政区旅游通行证号码 * ,*现连同本申请表一 并递交/现已报失/目前不能使用.而本人自获发给上述香港特别行政区旅游通行证后,从未申领其他香港特别行政区旅 游通行证. Hong Kong Special Administrative Region Travel Pass no. previously granted to me *is now attached/has been reported lost/is not available and that I have made no other application for a Hong Kong Special Administrative Region Travel Pass since the aforesaid Travel Pass was issued to me. (iv) 本人同意为办理本人的申请而进行任何所需的查询. I consent to the making of any enquiries necessary for the processing of my application. 本人声明就本人所知所信,在本申请表内所报的各项资料,均属正确、完备和真实. I declare that all information given in this application form is correct, complete and true to the best of my knowledge and belief. 日期 Date 申请人签署 Signature of applicant ID

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2 附录甲 Appendix A 领取香港特别行政区旅游通行证授权书 Authorisation for Collection of Hong Kong Special Administrative Region Travel Pass 注意s (i) 代领人须年满18岁,并须出示其香港身份证或旅行证件以证明其身份. Note: The authorised person must be over the age of

18 and has to produce his/her Hong Kong identity card or travel document for identification. (ii) 本授权书和香港特别行政区旅游通行证申请表上申请人的签署式样必须相同. The signature in this authorisation must be the same as that signed by the applicant on the Hong Kong Special Administrative Region Travel Pass application form. 本人授权 I authorise *Mr/Mrs/Miss/Ms *先生/太太/小姐/女士 持 *香港身份证/旅行证件号码 holding *Hong Kong identity card/travel document number 及居住在 and residing at 电话号码 telephone number 领取本人的香港特别行政区旅游通行证. to collect my Hong Kong Special Administrative Region Travel Pass. 申请人签署 Signature of applicant 姓名(正楷) Name in block letters 日期 Date * 请将不适用者删去 Please delete where inappropriate. ID

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3 说明事项Guidance Notes 引言香港特别行政区旅游通行证是为经常访港及持有有效护照而无须访港签证或进入许可的人士,作为进入香港特别行政区旅游之用. 申请人必须在递交申请表前

12 个月内,曾访港三次或以上(入境后离港前往中国内地或澳门地区后再返港的次数除外),而在这期 间并无不良纪录,或可令入境事务处处长信纳,申请人到访可为香港特别行政区带来实际的利益.虽然申请人可能符合上述申请条 件,入境事务处处长保留权利不签发香港特别行政区旅游通行证. Application is open to frequent visitors who hold valid passports and are eligible to come to the Hong Kong Special Administrative Region (HKSAR) without a visa or entry permit for visit purpose. Applicants should have genuine needs to visit the HKSAR frequently, and have come for visits trouble-free on three or more occasions (other than return from side trips to the Mainland of China or the region of Macao) in the 12-month period immediately preceding the application, or can satisfy the Director of Immigration that their visits may bring substantial benefits to the HKSAR. The Director of Immigration reserves the right not to issue a HKSAR Travel Pass even if the criteria stated above are fulfilled. Introduction 概况General (i) 你应以中文或英文填妥本申请表及签署.此申请表上所填的姓名及个人资料必须与你的有效护照上的资料相同. You should complete this application form in Chinese or English, and properly sign it. The name and other personal particulars in the application form must be identical to those appearing on your valid passport. (ii) 注意:任何人为取得香港特别行政区旅游通行证,作出或安排作出明知为虚假或自己亦不信为真确的陈述或申述,即属违法. Reminder: It is an offence in law, for the purpose of obtaining a HKSAR Travel Pass, to make any statement or representation which one knows to be false or does not believe to be true. (iii) 请以正楷填妥本申请表及贴上你的近照(显示头部正面,并且........