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 此栏由办理机关处理Immigration Department, the Government of FOR OFFICIAL USE ONLY the Hong Kong Special Administrative Region 档案条码 Reference barcode 无结婚纪录证明书申请书Application for Certificate of Absence of Marriage Record 注意: (i) 在填写本申请书前,请参阅说明事项.

Note : Please read guidance notes before completing this form. (ii) 请用黑色或蓝色笔以正楷填写本申请书. Please complete this form in BLOCK letters using black or blue pen. (iii) 领取本申请书无须缴费. This form is issued free of charge. (iv) ? 请在适当方格内填上「?」号. Please tick as appropriate. (v) * 如非亲身申请,请提供资料当事人的身份证副本. If not apply in person, please provide photocopy of data subject'

s identity card. 1. 个人资料 Personal Particulars 姓名 (中文) Name in Chinese 姓(英文 ) Surname in English 名(英文 ) Given names in English 别名 ( 如有 ) ( 中文 ) 姓(英文) Alias (if any) in Chinese Surname in English 名(英文) Given names in English 性别 男 出生日期 女Sex Male Female Date of birth 日dd 月mm 年yyyy 香港身份证号码 * HK identity card no.* ( ) 国籍 Nationality 旅行证件类别 (如有) 旅行证件号码 (如有) Travel document type (if any) Travel document no. (if any) 证明书上将会印上香港身份证号码或旅行证件号码,请选择你的意愿.(如选择旅行证件号码,请提供旅行证件正本.) Hong Kong identity card no. or travel document no. will be printed on the certificate, please show your preference. (If you choose travel document no., please provide original of travel document.) 香港身份证号码 旅行证件号码 Hong Kong identity card no. Travel document no. 你曾否在香港登记结婚 ? 如果 '

有'

,请填上结婚年份 有Yes 否No Have you ever registered a marriage in Hong Kong? If '

yes'

, please provide year of marriage 注: 若你在香港没有婚姻登记纪录,你将於缴交订明费用后获发无结婚纪录证明书;

若你在香港已有结婚纪录,则不会获发无结婚纪录证明书,你只会获发一封婚姻纪录函件. Note: If you have no marriage record in Hong Kong, you will be issued a certificate of absence of marriage record on payment of the prescribed fee. If you have marriage record in Hong Kong, you will NOT be issued a certificate of absence of marriage record but will be issued a letter of marriage record instead. 现时婚姻状况 未婚 Bachelor/Spinster 已婚 Married 离婚 Divorced 鳏夫寡妇 Present marital status Widower/Widow 本人现申请无结婚纪录证明书,理由为申请: (i) 於 其他国家 I apply for the issue of a Certificate of Absence of Marriage in 内地 结婚. Mainland other country Marriage Record for the purpose of application for: 注: 是项资料的提供属自愿性质,以用作统计用途. Note: The information in this item is provided on a voluntary basis for statistical purpose. 团聚 (ii) (iii) Reunion 遗产 v) 移民 其他 ( 请注明 ) (i (v) Migration Heritage Others (Please specify) 联络电话号码 内线 Contact telephone no. Ext. 电邮地址 (如有) E-mail address (if any) 地址 (请於边界内填写) Address (Please fill in within border) 签署 Signature ( 须与旅行证件上的签名相同 ) (same as that shown on travel document) 日期 Date 确认 Acknowledgement 本人确认已收到 * 无结婚纪录证明书 / 婚姻纪录函件 I acknowledge receipt of the * Certificate of Absence of Marriage Record / Letter of Marriage Record. 收件人签署 日期 Signature of recipient Date 此栏由办理机关填写 FOR OFFICIAL USE ONLY RF/CAMR Approved by 姓名及签署 日期 Name and signature Date MR