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表格八 香港特别行政区政府 电力条例(第406 章) 电力(注册)规例 新申请注册为电业工程人员/ 注册电业工程人员续期/ 更改电力工程级别申请表格 FORM

8 THE GOVERNMENT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION ELECTRICITY ORDINANCE (CAP.

406) ELECTRICITY (REGISTRATION) REGULATIONS NEW/RENEWAL/CHANGE OF GRADE OF ELECTRICAL WORK APPLICATION FOR ELECTRICAL WORKER REGISTRATION 此栏不用填写 For Official use only 收件日期: Receipt date: 收嗪: Receipt Number: (注意:填写此申请表格前请参阅「表格八备注」 .申请人应以正楷填写此申请表格各栏,并应在表格上签署.) (Note: Before you complete this form, please read carefully the notes on NOTES TO FORM

8 . The applicant should complete all sections of this application form in block letters and sign the form.) 致 机电工程署署长: To the Director of Electrical &

Mechanical Services, A 部:申请类别 (请在适当的申请项目空格内加上?号及o可选择一项申请类别) Section A: Type of Application (Please tick in the appropriate box and only one type of application is allowed) ? 申请续期 Renewal of Registration → 请到(B)及(C)部填写 Please complete section (B) &

(C) 其他之申请 Other applications: 请额外填写附加表格八(A) Please also complete appendix Form 8A 拟申请之电力工程级别(请参阅备注 3) Grade of electrical work applying (Please see note 3) ? 新申请注册为电业工程人员 New registration as an electrical worker 其他(请说明) (Please specify) ? 申请更改电力工程级别 Change of grade of electrical work ? 申请额外准许之电力工程 Additional permitted electrical work B 部:注册资料(o适用於已注册人士) Section B: Registration Particulars (for registered electrical worker only) 注册编号 Reg. No. 工程级别 Grade 届满日期 Expiry Date 日Day 月Month 年Year 准许之工程 Permitted Work C 部:个人资料(此项必须填写) Section C: Personal Particulars (This part must be completed) 先生 Mr. ? 小姐 Miss ? 女士 Ms ? 出生日期 Date of Birth 日Day 月Month 年Year 姓名(英文) (姓氏先行) Name in English (Surname first) 姓名(中文) Name in Chinese 姓名电码 C.C.C. No. 香港身份证号码 HKID No. ( ) 护照号码(如无香港身份证) Passport No.(If no HKID Card) 联络地址 Correspondence Address 电话号码(办事处/住宅) Telephone No. (Bus./Res.) 手提电话 Mobile Phone No. 传真号码 Fax No. 电邮地址 Email Address 本人声明在此申请表格填报的一切资料、陈述及附上的文件全属真确无讹.警告:如就此项申请作出虚假陈述或失实资料, 即属违法.本人亦已阅读及同意於本表格内之「个人资料私隐声明」 . I declare that all particulars, statements and documents submitted herein and with this application are true and correct. Warning: It is an offence in law to furnish any false statement or information related to this application. I also confirm that I have read and agreed with the Personal Data Privacy Statement in this Form. 申请人签署 Signature of Applicant 申请日期 Date of Application 日Day 月Month 年Year 回邮及通讯地址(此项必须填写) Return Postal and Correspondence Address (this part must be completed) 姓名 Name 姓名 Name 地址 Address 地址 Address CHK NA CG PW RA NQ NQ Insist submission COL CS9 MAIL CCC Recorded Required Passed Doc Req'

d CPD Recorded Passed PRV. APP. No. PHOTO Old record RPO Submitted on PAYMENT Apprv. Not Apprv. REMARK A? B? C? R? H+B? H+C? H? NS? WH? AC? CD? GF? Other? w? EMSD/EL/34?(04/2019)? D 部:其他资料(可选择填写) Section D: Other Particulars (Optional item) (1) 电力设计 / 安装 / 维修保养 / 定期检测 (WR2) 服务在您的工作量大概占多少? What proportion of your works in respect of electrical design / installation / repair &