香港宽减计划申请3.doc

香港特別行政區政府 The Government of Hong Kong Special Administrative Region 遠洋船舶在香港泊岸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 泊岸轉油聲明 Fuel Switching Declaration Form 本表格和有關文件必須在船隻離開香港水域後3天內遞交到海事處。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，遞交所需文件。 This completed form and the supporting document must be submitted to the Marine Department within 3 days after the vessel leaving Hong Kong waters. The shipping agent or shipmaster can submit this form and the required document to the Marine Department by Electronic Business System (eBS), fax at (852) 2543 8299 or counter service at counter 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 海事處申請編號 環保署登記編號umber 國際海事組織編號IMO Number 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) 為支持我/我們申請港口設施及燈標費寬減計劃(寬減計劃)的申請，我/我們現為以上船隻遞交泊岸轉油聲明。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: 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In support of my/our application for the grant of the Concession under the Port Facilities and Light Dues Incentive Scheme (the ‘Incentive Scheme’), I/we hereby submit the Fuel Switching Declaration Form for the above vessel (‘Vessel’). I/we understand that the shipping agent /shipmaster of the Vessel have to submit to the Director of Marine 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 respective, indicating the fuel switchover time upon arr