管有许可证申请表.doc

管有許可證申請表 此欄由辦理機關填寫 For official use only PL 香港法例586章保護瀕危動植物物種條例 動物標本Animal specimens □ Application for a LICENCE TO POSSESS 植物標本Plant specimens □ Protection of Endangered Species of Animals and Plants Ordinance, Cap. 586 填寫此申請表前請先詳閱附加的注意事項內容Please read the attached notes before filling in this application form 1. 申請人姓名／公司名稱及地址 Name of Applicant/Company Address 2. 存放地址 Address of keeping premises 聯絡人姓名 Contact Person’s Name ………………………………………………………… 電話 傳真 Telephone: Fax: 3. 公司的香港商業登記證號碼 H.K. Business Registration No. of Company 或or 申請者身分證/護照號碼 Identity Card/Passport No. of Applicant 4. 用途：(請參考附加的注意事項) Purpose : (Please refer to attached notes) 動/植物標本詳細內容 (如多於壹個物種，請填附頁。) Details of Animals and Plants specimens ( If more than one species, please fill in annex) 序號 No.1 5. (a) 該標本根據下列管有許可證轉讓或進口許可證獲得 The specimens were acquired under the following licence: 管有許可證號碼Possession licence No.: APO/PL 或OR 進口許可證號碼Import licence No. : APO/IL (b) 先前供應商相關的標本交易發票號碼及日期 Invoice No. and Date of specimens under application relating to the previous supplier to the applicant …… 6. 動/植物的物種Species of animal/plant (a) 學名（拉丁文名稱）Scientific Name 7. 公約# 附錄編號 (Ⅰ、Ⅱ或Ⅲ）及來源 (請參考附加的注意事項） CITES # Appendix No. (I, II or III) and source (please refer to attached notes) 8. 標本的描述 (如活生、毛皮或根等） Description of specimens (e.g. live, skin, root) 9. 最高數量： 數目(頭/件)、 重量(公斤)等 Maximum Quantity : number (head/pc), weight (kg), etc. (b) 俗名Common Name 本人已閱畢附加的應注意事項及警告，並聲明上面各項填報詳情均為正確無訛。本人明白必須完全遵守證上所列各項條件，獲發的許可證方為有效。I have read the attached notes and warning and I declare that all the particulars given above are true and correct. I understand that any licence, if issued, is valid only when all the licence conditions stipulated on the licence are fully complied with. 申請人簽署Signature of Applicant : 公司印鑑Company chop 日期Date : 此欄由辦理機關填寫For official use only Date Received Remarks/Additional Information Licence prepared : APO/PL Date : By : #