TheGovernmentoftheHongKongSpecialAdministrativeRegion..docVIP

香港特別行政區政府 UP/ExtUP The Government of the Hong Kong Special Administrative Region For Official Use 《有毒化學品管制條例》(第595章) Reference No. Hazardous Chemicals Control Ordinance (Chapter 595) 申請 使用/ 續期使用* 受管制化學品許可證 Application for Permit To Use / Renewal of Permit to Use* Scheduled Chemicals 1. 許可證申請人Permit Applicant 申請人名稱 (個人或公司) Name of Applicant (person or company) (英文English): ________________________________________________________________________________ (中文Chinese): 商業登記號碼 (如有) Business Registration Certificate No. (if any): 香港身份證╱護照 * 號碼 (如由個人申請) H.K.I.D. Card / Passport * No. (for application made by a person only): ___________________________________ 現時許可證號碼 (如申請許可證續期) Current Permit No. (for permit renewal only): ________________________________________________________ 現有許可證屆滿日期 (如申請許可證續期) Current Permit Expiry Date (for permit renewal only): _________________________________________________ 申請人地址 (如申請人是公司，請在此欄提供公司註冊地址) Applicant’s Address (if applicant is a company, please provide the registered address of the company below): 通訊地址 (如與申請人地址不同) Correspondence Address (if different from the applicant’s address): 電話號碼 Telephone No.: 傳真號碼 Fax No.: 聯絡人姓名 Name of Contact Person: 聯絡人職位 Position of Contact Person: 聯絡人電話號碼 Contact Person’s Telephone No.: 電郵地址 Email Address: __________________________________ 業務性質 Business Nature: * 請刪去不適用者 Please delete if not applicable 2. 申請涉及的受管制化學品的詳細資料和操作摘要 (請填寫附件US-1及附件US-2) Details of the Scheduled Chemicals under Application and Operation Brief (Please complete Annex US-1 and Annex US-2) EPD HCC5 (9/2008) 第 1 頁 / 共 ______頁 Page 1 of _______ 3. 申請人聲明Applicant’s Declaration 據本人所知及所信，於此申請表中所提供的資料，包括 張附件US-1和 張附件US-2中的資料，全屬真實無訛，此證。 I hereby certify that the particulars given under this application, including those in the pages of Annex US-1 and pages of Annex US-2 are correct and true to the best of my knowledge and belief.