PDF《香港特别行政区政府入境事务处》

2 人资料(续) Personal Particulars (Continued) 婚姻状况 Marital status 未婚 Single 已婚 Married 分居 Separated 离婚 Divorced 丧偶 Widowed 配偶的中文及英文姓名 (如适用)配偶职业 (如适用)Name of spouse in Chinese and English (if applicable) Occupation of spouse (if applicable) 访港目的 拟逗留的时间 Reason for visit Proposed duration of stay 4. 谘询人资料 Particulars of Referee (请参阅「说明事项」第5段)(Please see paragraph

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) 姓名 (中文) (如适用)Name in Chinese (if applicable) 姓 (英文) Surname in English 名 (英文) Given names in English 性别 Sex 男Male 女 出生日期 Female Date of birth 日dd 月mm 年yyyy 香港身份证号码 (如有)联络电话号码 Hong Kong identity card no. (if any) ( ) Contact telephone no. 电邮地址 (如有)E-mail address (if any) 住址 (请於边界内填写)办事处地址 (如适用)(请 於边界内填写)Residential address (please fill in within border) Business address (if applicable) (please fill in within border) 职业 办公室电话号码 内线 Occupation Office telephone no. Ext. 5. 声明 Declaration (请参阅「说明事项」第6段)(Please read paragraph

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) 本人,即下开签署人,声明: I, the undersigned, declare that: (i) 救怂叭沸,本申请表第

1 至2页内所填报的资料均属正确、完备和真实.此外,本人已阅读过「说明事项」,并清楚明白 其内容. The information given in this application form, namely pages l to 2, is correct, complete and true to the best of my knowledge and belief and that I have read and understood the '

Guidance Notes'

. ? (ii) *本人/该儿童以往从未在任何时间申请、持有或被拒发香港入境许可证. * I have/The child has not previously applied for, held or been refused a Hong Kong entry permit at any time. ? (iii) *本人/该儿童以往曾获签发的香港入境许可证号码 ,*现连同本申请表一并递交/现已报失/目前 不能使用.而 *本人/该儿童自获发给上述入境许可证后,从未申领其他香港入境许可证. Hong Kong entry permit number previously granted to *me/the child *is now attached/has been reported lost/is not available and that *I have/the child has made no other application for a Hong Kong entry permit since the aforesaid permit was issued to *me/the child. (iv) *本人/该儿童并无持有由台湾当局以外机关签发的任何旅行证件[ 《台湾居民来往大陆通行证》 (俗称「台胞证」 )除外] . *I am/The child is not in possession of any travel document issued by other authorities outside Taiwan (except Mainland Travel Permit for Taiwan Residents (commonly known as Tai Bao Zheng )). (v) 本人同意入境事务处处长为办理此项申请而需进行的有关查询. I consent to the Director of Immigration making of any enquiries necessary for processing the application. 若由父/母或合法监护人签署,请填写此栏 To be completed if signed by parent/legal guardian 父/母/合法监护人的姓名 Full name of parent/legal guardian 与该儿童的关系 Relationship to the child 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/父/母/合法监护人签署 * Signature of applicant/parent/legal guardian ID 78H (04/2014)

3 说明事项Guidance Notes 收费 Fee 签发此入境许可证的费用,请参阅收费表 ID 912. The fee for the issue of this Entry Permit is shown in fee leaflet ID 912. 航空公司档案号码 Airline Reference Number 为方便办理申请工作,航空公司办事处会在申请表上写上档案号码.如有遗漏,请向航空公司办事处查询. To ensure smooth processing of the application, the application form should bear the reference number allotted by the airline office. You should clarify with the airline office in case the reference number is missing. 填写表格及递交申请 Form completion and submission (i) 申请表须用黑色或蓝色笔,并以中文或英文填写.表格填妥后,应连同下列证件一并递交航空公司办事处: The application form may be completed in Chinese or English but must be in black or blue ink. It should be returned to the airline office together with the following: (1) 台湾身份证或显示身份证号码的台湾旅行证件副本.如未能递交该等证件,则须用书面解释未能递交的原因;