香港宽减计划申请2.doc

香港特別行政區政府 The Government of Hong Kong Special Administrative Region 遠洋船舶在香港停泊時使用清潔燃油的港口設施及燈標費寬減計劃 Port Facilities and Light Dues Incentive Scheme for Ocean Going Vessels Using Cleaner Fuel While Berthing in Hong Kong 申請表格及聲明 Application-cum-Declaration Form 本表格必須在船隻泊岸轉油後，不遲於4小時內遞交到海事處。船隻代理人或船長可透過海事處的電子業務系統、傳真 (852) 2543 8299或親臨香港統一碼頭道38號海港政府大樓3樓東翼307室1、2號櫃台，遞交本表格。 This completed form must be submitted to the Marine Department no later than 4 hours after switching fuel at berth. The shipping agent or shipmaster can submit this form to the Marine Department via Electronic Business System (eBS), fax at (852) 2543 8299 or counter service at counters 1 and 2 of Room 307, 3/F, East, Wing, Central Marine Office, Harbour Building, 38 Pier Road, Hong Kong. 第一部Part I 參與船隻資料Particulars of Vessel 船名Name of Vessel 呼號Call Sign 船籍 Nationality of Vessel 船隻類型Type of Vessel 國際海事組織編號IMO Number 編號umber 第二部 Part II 船隻代理人資料 Particulars of Shipping Agent 船隻代理名稱 Name of Agent 船隻代理地址Address of Agent 聯絡人Contact Person 流動電話號碼 Mobile Phone No. 電話Telephone 傳真Fax 電郵Email To: Director of Marine (the ‘Director) on behalf of the HKSAR Government (the ‘Government’) 致: 海事處處長 (處長) 代表香港特別行政區政府 (政府) 我/我們現為以上船隻遞交參與港口設施及燈標費寬減計劃(寬減計劃)的申請。 I/We hereby submit the application for the grant of the Concession under the Port Facilities and Light Dues Incentive Scheme (the ‘Incentive Scheme’) in respect of the above vessel (the ‘Vessel’). 我/我們明白船隻代理人/船長必須在船隻離開香港水域後3天內向海事處處長遞交以下文件，以支持申請此寬減計劃內的減免： 由船隻代理人及船長簽妥的泊岸轉油聲明，顯示船隻抵岸及離岸時的轉油時間，當中「船長承support my/our application for grant of a Concession under the Incentive Scheme, I understand that the shipping agent / shipmaster will have to submit to the Director of Marine Department the following documents within 3 days after the Vessel leaving Hong Kong waters: Completed Fuel Switching Declaration Form signed by the shipping agent and shipmaster, indicating the fuel switchover time upon arrival and departure from berth. The section of “Underta