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 注意 (i) 请用黑色或蓝色笔以正楷填写本申请书.

Immigration Department, the Government of Note: Please complete this form in BLOCK letters using black or blue pen. (ii) 请在适当方格内填上「?」号. the Hong Kong Special Administrative Region Please tick as appropriate. 香港特别行政区护照申请书 警告! 如就此项申请作出虚假陈述或填报失实资料,即属违法. ! (适用於十六岁或以上人士在香港以外地区的申请) Warning: It is an offence in law to furnish any false statement Application for HKSAR Passport or information relating to this application. (For persons

16 years of age or above applying outside Hong Kong) 三十二页

32 pages 或or 首次申请 First application 或or t 换领 Replacemen 或or 1. 2. 申请类别 护照类别

48 pages 因遗失/损毁/更改 料的申请 四十八页 个人资 Application due to loss / Type of Passport Type of Application damage / amendment of personal particulars 3. 个人资料 Personal Particulars (以香港永久性居民身份证所载者为准 As stated on Hong Kong permanent identity card ) 姓 (中文) 姓 (英文) Surname in Chinese Surname in English 名 (中文) 名 (英文) Given names in Chinese Given names in English 性别 男女出生日期 Sex Male Female Date of birth 日dd 月mm 年yyyy 签发日期 Date of issue 香港永久性居民身份证号码HK permanent identity card no. ( ) 此栏由办理 机关处理 日dd 月mm 年yy 出生地点 Place of birth For Official 香港 内地 in Mainland 澳门 中国 Hong Kong 其他省、直市或自治区 Macau Use Only China Other province, municipality or autonomous region ( ) (请注明名称 Please state name) 其他国家 Other (请注明国家名称 Please state country name only) country 现时住址 (请於边界内填写) Present address (Please fill in within border) 联络电话号码 Contact telephone no. 香港谘询人姓名 (如适用) Name of Referee in H.K. (if applicable) 香港谘询人电话号码 (如适用) Referee?s H.K. tel. no. (if applicable) 4. 附加资料(如有) Additional Information (if any) 香港谘询人住址 (如适用) Referee?s address in H.K. (if applicable) 5. 未满十八岁申请人的父、母或合法监护人同意书 Consent from Parent or Legal Guardian for Applicant under

18 Years of Age 本人,即下开签署人,现谨此声明: I, the undersigned, declare that: (2) 本人对申请人的监护权并未受任何法院颁令所限制. (1) 本人乃申请人的: My relationship with the applicant is My rights in respect of the applicant have not been limited in any way by the order of 母亲 父亲 法庭颁令监护人 获授权的监护人 any court. mother father legal guardian (by court order) legal guardian (by authorisation) (3) 本人同意此护照申请. I consent to this application for the issue of a passport to him/her. 中文姓名 本人的香港身份证号码 Name in Chinese HK identity card no. ( ) 如非香港居民,请填写旅行证件 英文姓名 类别及号码: Name in English For non-Hong Kong resident, please state travel document type &

no.: 日期 签署 Date 日dd 月mm 年yyyy Signature 6. 申请人声明书 Declaration of Applicant 本人,即下开签署人,现谨此声明: I, the undersigned, declare that: (3) 就本人所知及相信,此申请书所填报的资料均属正确无误. (1) 本人是中国公民及本人从未向香港入境事务处作出变更国籍的声明. The information given in this application is correct to the best of my knowledge and belief. I am a Chinese citizen and I have not made any declaration of change of nationality to the Immigration (4) 本人同意为处理此申请而须进行的任何查询. Department, Hong Kong. I consent to the making of any enquiries necessary for the processing of this application. (2) 本人作此申请时身在 When I make this application, I am staying in (请填写国家名称 Please state name of country) 签署 日期 Signature Date 日dd 月mm 年yyyy 注意 Note: 请於边界内签署 Please sign within border ID843(12/2017) My My 收集资料的目的 Purpose of Collection 申请书内所提供的个人资料,会供入境事务 The personal data provided in the application form 处作下列一项或多项用途: will be used by Immigration Department for one or more of the following purposes:- 一 办理你的申请;