PDF《香港海关》

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, please provide the following details) 请提供共用处所的业务的以下资料:― Please provide the following information of the business sharing the premises:- ? 由申请人公司经营,业务性质为:― Run by the applicant, the nature of business is:- ? 由其他经营者经营,请提供以下资料:― Run by other business entity, please provide the following information:- 共用处所的业务的资料:― Particulars of the business sharing the premises:- 业务 / 法团名称 Name of Business / Corporation 香港海关CUSTOMS AND EXCISE DEPARTMENT 表格5要求加入新的用以经营金钱服务的处所申请书 Form

5 Application to add New Premises used for the operation of a Money Service *

3 请删去不适用者*Please delete as appropriate 请在适当方格内加上 ? 号Please ? as appropriate CED

403 (Rev. 03/2018) 第2部C拟加入用以经营金钱服务的特定处所的资料(续) Part

2 - Details of the Particular Premises used for the operation of a Money Service (Continued) 业务性质 Nature of Business (a) ? 汇款服务 Remittance service (b) ? 货币兑换服务 Money-changing service (c) ? (a) 及(b) 的服务 Both (a) and (b) (d) ? 其他,请述明:― Others, please specify:- 金钱服务经营者牌照号码 (如适用) MSO Licence No.(if applicable) (如有超过

1 间公司共用处所,请用另纸提供资料) (If more than one company shared the premises, please provide the information in a separate sheet.) (5) 占用人的同意 (只适用於用以经营金钱服务的 住宅处所 ) Occupant'

s Consent (only applicable for domestic premises used for the operation of a money service) 递交申请时,你 必须 提供所有占用人的姓名,并取得所有占用人的同意书.请确保每位占用人都已阅读於填 表须知第 C 部所载的收集个人资料声明. You must provide the names of occupants and obtain the letters of consent from all of them when you submit the application. Please ensure that each of the occupants has read the Personal Information Collection Statement in Part C of the Guidance Notes. 占用人姓名 Name of Occupants (1) (2) (3) (4) (5) (6) (如占用人超过

6 名,请用另纸提供资料) (If more than six occupants are involved, please provide the information in a separate sheet.) 注: 如有其他处所需作出申请,请影印本申请表格第

2 部,用以提供其他处所的资料. Remarks: If you have other business premises for application, please make a photocopy of Part

2 of this application form for filling in the particulars of the other business premises. 香港海关CUSTOMS AND EXCISE DEPARTMENT 表格5要求加入新的用以经营金钱服务的处所申请书 Form

5 Application to add New Premises used for the operation of a Money Service *

4 请删去不适用者*Please delete as appropriate 请在适当方格内加上 ? 号Please ? as appropriate CED

403 (Rev. 03/2018) 第3部C提交此申请表格人士的声明 (见於第

3 部内的备注) (请於会见时签署及盖章) Part

3 CDeclaration by the person who submits this application form (see Remarks in Part 3) (Please sign and stamp at the time of interview) 本人谨此声明:- I declare that:- (a) 在本申请表格提供的所有详情及资料(包括附加页),共页,全属真确无误. The particulars and information given in this application form including additional sheet(s) consisting of page(s) are true and correct;

(b) 本人承诺采取措施,以确保如本申请表格内第

2 部所提供的详情有任何改变,持牌人须在自改变发生之日 起计的一个月内,藉书面向海关关长具报有关改变事项.本人明白根蚧飨辞趵