濒危物种公约再出口证明书申请表.doc

瀕危物種公約再出口證明書申請表 此欄由辦理機關填寫For official use only RC Application for a CITES RE-EXPORT CERTIFICATE 動物標本Animal specimens □ 漁農自然護理署 植物標本Plant specimens □ Agriculture, Fisheries and Conservation Department 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 聯絡人姓名 Contact Person’s Name: …………………………………………..…………… 電話 傳真 Telephone: Fax: ………………… 2. 收貨人姓名及地址 Consignee’s Name Address 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. (a) 用途：(請參考附加的注意事項) Purpose : (Please refer to attached notes) (b) 擬出口的日期 Proposed date of export …… (c) 運輸方法：空運/船運/火車/貨車/其他（請說明） Transportation : By air/ship/train/truck/others (Please specify) 動/植物的物品詳細內容 (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) 獲得物品的日期： The specimen was acquired on : (date) (b) 申請物品的入口商及其後各貿易商的有關發票號碼及日期 Invoice No. and Date of items under application relating to importer and all subsequent traders 6. (a) 扣除本再出口證明書的使用量後，根據第12欄提及的准許證或證明書 所持有的原料： Stock balance of raw materials kept under the permit or certificate stated in Box 12 after deduction by this Re-Export Certificate: (b) 本再出口證明書所扣除的物種貨品數量: Quantity of specimens deducted by this Re-export Certificate: 7. 動/植物的物種Species of animal/plant (a) 學名（拉丁文名稱）Scientific Name (b) 俗名Common Name 8. 公約# 附錄編號 (Ⅰ、Ⅱ或Ⅲ）及來源。 如屬非公約物種請填NC (請參考附加的注意事項） CITES # Appendix No. (I, II or III) and source. Please declare NC for non-CITES species (please refer to attached notes) 9. 標本的描述 (如活生、毛皮 或根等） Description of specimens (e.g. live, skin, root) 10. 數量： 數目(頭/件)、 重量(公斤)等 Quantity : number (head/pc), weight (kg), etc. 11. 原料或物品的來源地： Country (Region) of Origin of raw material or specimens 12. 先前出口地的公約# 出口准許證或 其他產地證明書號碼： CITES# Permit of Previous Export or other Certificate of Origin No. 本人已閱