PDF《香港特别行政区政府入境事务处》

1.

入境许可证的种类 Type of Entry Permit (请参阅「说明事项」第2段)(Please read paragraph

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Guidance Notes'

) (甲) 请注明所申请的入境许可证类别. (a) Please indicate the type of permit you are applying for.

16 页D有效期一年

16 pages D valid for one year

32 页D有效期三年

32 pages D valid for three years (乙)申请类别 (b) Type of application 初次申请 First application 换领 Renewal 补领(遗失/损坏) Re-issue (loss/damage) 2. 退回已注销的多次入境许可证 Return of the cancelled Multiple Entry Permit (请参阅「说明事项」第8段)(Please read paragraph

8 of the '

Guidance Notes'

) 本人要求退回已注销的多次入境许可证 (只适用於续领多次入境许可证)Irequest to return the cancelled Multiple Entry Permit (Applicable ONLY to renewal of Multiple Entry Permit). 3. 个人资料 Personal Particulars 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 女 出生日期 出生地点 Female Date of birth 日dd 月mm 年yyyy Place of birth 台湾身份证号码 在台湾的居留时间共 年Taiwan identity card no. Duration of residence in Taiwan Years 持有可用以返回台湾的旅行证件 Travel document held for returning to Taiwan 类别 号码 签发地点 Type Number Place of issue 签发日期 届满日期 Date of issue Date expi y 日of r dd 月mm 年yyyy 日dd 月mm 年yyyy 回境证或签证的届满日期 (如持有这类证件)Date of expiry of re-entry permit or visa (if applicable) 日dd 月mm 年yyyy 现时住址 Present address ( 请於边界内填写)(please fill in within border) 照 原居地住址 (如与上述不同)Address at place of domicile (if different from above) 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) 职业 (请填写现时的职位.如担任任何官职或政府职位,亦须列明)雇主姓名及地址 Occupation (Please specify current post. Please also state any official or government position currently holding) Name and address of employer 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 photocopy or downloaded copy. 日期 Date *申请人/父/母/合法监护人签署 *Signature of applicant/parent/legal guardian ID 78H (04/2014)

1 航空公司档案号码 Airline reference no. 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 申请由台湾来港旅游入境许可证D多次入境Application for an Entry Permit to Visit the Hong Kong Special Administrative Region from D Taiwan Multiple Entries 注意s (i) 填写本表格前,请参阅「说明事项」 .Please read '

Guidance Notes'

before completing this form. Note : (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. (vi) ? 将不适用者删去及签名. Cross out whichever does not apply and sign. 此栏由办理机关处理FOR OFFICIAL USE ONLY 档案条码 Reference barcode 3. 个ID 78H (04/2014)