SampleFormDH1271(S).PDFVIP

Sample Form DH1271(S) (YOU MUST COMPLETE ALL ITEMS) RADIATION ORDINANCE (Chapter 303) APPLICATION FOR IRRADIATING APPARATUS LICENCE I ABC Company Limited (Name of fu l l ) of Information (Address in fu l l ) hereby make application for a licence to ( a ) to possess irradiating apparatus as described hereunder, at (b ) Information 2. Description of type or types of irradiating apparatus for which licence is required : dental X-ray machine 3. My qualifications are as follows (c) (fill in information as applicable) Signature of Applicant. ( a ) S t a t e p u rp o s e f o r w h i c h l i c en c e i s r e q u i red , i . e . t o p o s se s s , s e l l , ma n u f a c tu r e , o p e ra t e , e t c . ( b ) S t a t e add r e s s a t w h ic h s u c h i r r a d i a t in g a p p a r a tu s wi l l b e s i t u a t ed . ( c ) T h i s p a r ag r aph n ee d on l y b e c o mp l e t ed in t h e c as e o f a n a p p l i c a t io n t o o p e ra t e i r r ad i a t i ng app a r a tu s . Date this 12 day of May 20 07 1 Sample Form (表格樣本 ) IA-P2 輻 射 條 例 ( 第 303 章 ) RADIATION ORDINANCE (CAP 303) 新申領管有一具處於可運作狀態的輻照儀器的牌照 Firs t Applicat ion for a Licence to possess an Irradiat ing Apparatus in a funct ional s ta te 請參閱夾附的「申請須知」後，填寫本表格適用部分。 Please refer to the a t tached Notes for Appl icants and complete the appropria te sect ions. 請在適當地方加上 Please t ick as appropr iate A. 申請人資料 Par t iculars of the applicant 以個人名義申請牌照，請填寫 A1 段；以公司名義申請牌照，請填寫 A2 段。 Licence in the name of a person, p lease complete Section A1; Licence in the name of a company, please complete Sect ion A2. 姓名 Name 陳大文 CHAN TAI MAN 中文 ( i n Ch ine s e ) 英文 ( in E ng l i sh ) 姓 ( Su r n a me ) 名 (Given name) 身分證編號 Ident i ty Card No. A123456(7) A1 或 or 公司名稱 Name of company AB