PDF《香港特别行政区政府》

PPRD12F03B (03/2017) -1- 香港特别行政区政府 THE GOVERNMENT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION 除害剂条例 (第133 章) PESTICIDES ORDINANCE (CAP.

133) 除害剂许可证申请表 (请填写一式两份) APPLICATION FOR PESTICIDES PERMIT (To be completed in duplicate) [填写本申请表前,请参阅 申请除害剂许可证指南 及 附录 A C 申请除害剂许可证所需资料摘要 ] [Before completing this application form, please read the Guide to Application for a Pesticides Permit and Appendix A - Information Required for Applying for a Pesticides Permit ] 第I部: 申请人资料 PART I: PARTICULARS OF APPLICANT 公司名称 Name of Company 中文 Chinese 英文 English 公司地址 Office Address 通讯地址 (如与上述不同) Correspondence Address (If different from the above address) 负责人资料 Particulars of the Responsible Person 姓名 Name 中文 Chinese *先生/女士 英文 English *Mr / Ms 香港身份证/护照号码 H.K. Identity Card / Passport No. 职衔 Post Title 电话号码 Phone No. 传真号码 Fax No. 电邮地址 E-mail Address 除害剂处理人资料 (如与负责人不同) Particulars of the Pesticide Handler (If different from the Responsible Person) 姓名 Name 中文 Chinese *先生/女士 英文 English *Mr / Ms 香港身份证/护照号码 H.K. Identity Card / Passport No. 职衔 Post Title 电话号码 Phone No. 传真号码 Fax No. 电邮地址 E-mail Address (*请删去不适用者 Please delete where not applicable) PPRD12F03B (03/2017) -2- 第II 部: 除害剂资料摘要 PART II: SUMMARY OF INFORMATION ON THE PESTICIDE 商标/产品名称 Brand / Product Name 活性成分通用名称(1) (ISO 或ANSI 或BSI)# Common Name(s) of Active Ingredient(s)(1) (ISO or ANSI or BSI)# 活性成分化学名称 (IUPAC)# Chemical Name(s) of Active Ingredient(s) (IUPAC)# 活性成分浓度及单位(1) Concentration(s) and Unit(s) of Active Ingredient(s)(1) 重量/重量百分比 (% w/w) 重量/体积百分比 (% w/v) 其他 Others 剂型类别 (剂型缩写)(2) Type of Formulation (Formulation Abbreviation)(2) ( ) 除害剂类别 Type of Pesticide 除\剂 Acaricide 除藻剂 Algicide 防蚝漆 Antifouling Paint 除真菌剂 Fungicide 除草剂 Herbicide 除虫剂 Insecticide 杀螺剂 Molluscicide 杀线虫剂 Nematicide 杀鼠剂 Rodenticide 实验室用途 Laboratory Use 其他 Others 附表所列除害剂 Scheduled Pesticide 附表

1 附表

2 第1部不适用 Schedule

1 Part

1 of Schedule

2 N.A. 输入目的 Purpose of Import 预计首批除害剂付运日期及数量 Intended Date &

Quantity of the First Shipment 除害剂包装 Packaging of Pesticide (请在适当位置加上 ? 号Please put a ? where appropriate) (1) 如有多於一种活性成分,请以符号 / 分隔每种成分的相关资料 (例如: A/B/C) If there are more than one active ingredient, please use the symbol / to separate the related information on each ingredient (e.g. A/B/C) (2) 剂型类别及缩写请浏览渔护署网页 Please refer to AFCD website for type of formulation and abbreviation # 缩写 Abbreviations: ANSI = 美国国家标准协会 American National Standards Institution BSI = 英国标准协会 British Standards Institution ISO = 国际标准化组织 International Organization for Standardization IUPAC = 理论化学和应用化学国际联会 International Union of Pure and Applied Chemistry PPRD12F03B (03/2017) -3- 第III 部: 除害剂许可证类别 PART III: TYPE OF PESTICIDES PERMIT 本申请是为在下述地址就第 II 部所述的附表所列除害剂/未经注册除害剂拟进行有关活动而提出. This application is made in respect of the scheduled/unregistered pesticide set out in Part II above for the following intended activities to be carried out at address(es) specified below. 处所地址 Address of Premises I. 输入 Import ? 於at II. 制造 (包括重新包装) Manufacture (including repackaging) ? 於at III. 售卖 Sale ? 於at IV. 供应 Supply ? 於at V. 管有 Possession ? 於at VI. 使用 Use ? 於at VII. 贮存 Storage ? 於at VIII. 出口 (只适用於附表所列除害剂) Export (for scheduled pesticides only) ? 於at IX. 转运 (只适用於附表所列除害剂) Transhipment (for scheduled pesticides only) ? 於at (请在适当位置加上 ? 号Please put a ? where appropriate) PPRD12F03B (03/2017) -4- 重要事项 IMPORTANT NOTES ? 请确保已递交 附录 A C 申请除害剂许可证所需资料摘要 提及的一切所需资料及证明文件. Please ensure that all the necessary information and supporting documents as required in Appendix A CInformation Required for Applying for a Pesticides Permit are submitted. ? 《除害剂条例》(第133 章)第15A 条赋予的权力,可为确定该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本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) 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. ? 为遵守世界贸易组织《与贸易有关的知识产权协议》第39(3)条的规定并在该条的规限下,所有得来不易的 未公布测试资料或其他资料在送交渔农自然护理署作申请除害剂许可证用途后会: - 被视作机密资料并加以保密;