PDF《Enclose the following :》

香港特别行政区政府 除害剂条例(第133章) THE GOVERNMENT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION PESTICIDES ORDINANCE (CAP.

133) 除害剂牌照续牌申请书 本人(持牌人) I, (Licensee) APPLICATION FOR PESTICIDES LICENCE RENEWAL 谨代表(公司名称) On behalf of (Company Name) 公司地址 Company Address 电话Telephone No.传真号码Fax No.电邮E-mail 1. 现附上 Enclose the following : (i) 缴交续牌费用 (请参阅右方机印之金额.如用支票,请划线及抬头『香港特别行政区政府』) Payment for the renewal fee (Please refer to the amount indicated on the right. Cheques should be crossed and made payable to 'The Government of the Hong Kong Special Administrative Region'.) 续牌费用Fee: (ii) 有效的公司商业登记证影印本 A photocopy of the valid Business Registration Certificate(s). BRC No.: 2. 申请更改项目(如有更改始须填写)Application for variation (complete only if appropriate) 在申请续牌的同时,本人拟一并申请在除害剂牌照上作下述更改 Concurrent with this renewal request, I also apply for the following change(s) to the Pesticides Licence. 持牌人更改为 (*先生/女士) Licensee change to (*Mr/ Ms.) 姓: 名: *身分证/护照 号码 Identity Card / Passport No. Surname: Given name: 通讯地址改为 Correspondence address change to # 其他 Other 营业地址改为 Business address change to * 请删去不适用的项目 Delete where not applicable # 《除害剂条例》(第133章)("条例")第15A条赋予权力,可为确定条例是否已经或正在获遵从而行使.其中权力包括督察或海关人员如合理地怀疑在此申请表 中述明的任何处所或地方(不论是否住宅)内有制造、使用、存放、贮存、售卖、要约售卖或为售卖而展示、供应或要约供应除害剂的情况正在发生,该 督察或人员可在任何合理时间,无需手令而进入该处所或地方.Powers under section 15A of the Pesticides Ordinance (Cap. 133) ("the Ordinance") may be exercised for the purpose of ascertaining whether the Ordinance has been or is being complied with. Such powers include, amongst others, entry without a warrant by an inspector or a member of the Customs and Excise Service, at any reasonable time, of any premises or place (whether domestic or not) stated in this application form on which the inspector or member reasonably suspects a pesticide is being manufactured, used, kept, stored, sold, offered or exposed for sale, or supplied or offered to be supplied. (持牌人签署) (Signature of Licensee) (公司印鉴) (Company Chop) (职位) (Position in Company) (日期) (Date) 申请方法 Method of application: ( I ) 如用邮寄方法申请,请把申请书寄往『九龙长沙湾道303号长沙湾政府合署5楼』. If apply by mail, please send the application to "5/F, Cheung Sha Wan Government Offices,

303 Cheung Sha Wan Road, Kowloon." ( II ) 如欲亲临办理,请先到长沙湾政府合署5楼3-4号窗.If apply in person, please go to "counter no. 3-4, 5/F., Cheung Sha Wan Government Offices" first. 个人资料收集声明 Personal Information Collection Statement ? 你所提供的资料将用作申请本署的除害剂牌照、许可证或注册的有关事宜.The information provided by you will be used for purposes relating to the application for pesticides licence, permit or registration in this Department. ? 本署可能会将你的资料或部份资料提供给任何代理商、承包商或其他政府部门作统计或调查之用途.The said information or any part thereof may be supplied by this department to any agent, contractor or other government departments for statistics or investigation purpose. ? 除个人资料(私隐)条例所订明的豁免外,你有权查阅和改正你的个人资料.Subject to exemptions under the Personal Data (Privacy) Ordinance, you have a right of access and correction with respect to personal data. ? 查阅和改正个人资料的要求应以书面形式向渔农自然护理署署长提出,地址为九龙长沙湾道303号长沙湾政府合署5楼,同时请注明你在本署的档案 号码.Request for personal data access and correction should be addressed to Director of Agriculture, Fisheries and Conservation at 5/F., Cheung Sha Wan Government Offices,