PleasereadtheGuideToApplication–Energy-cum-carbon.docVIP

Please read the “Guide To Application – Energy-cum-carbon Audit Projects” before completing this form. You may complete this Application Form in Chinese or English. 填表前請參閱《能源及二氧化碳排放綜合審計項目- 申請指引》。請以中或英文填寫本表格。 Completed Application Form in both hard and soft copies should be returned to Please state “Energy-cum-carbon Audit Projects” on the envelope : 填妥的表格 正本及軟複本 請送交 信封面請註明「能源及二氧化碳排放綜合審計項目」 : 香港九龍啓成街3號機電工程營運基金劃 Tel 電話 : Fax傳真 : E-mail電郵 : Section A – Data Sheet 甲 部 – 資料頁 Applicant Organisation 申請機構 Name of Applicant 申請機構名稱 English英文 Chinese中文 Mailing Address 通訊地址 閱Person-in-charge 負責人 Name 姓名 Position Held 職位 Name of ompany/ Organisation 公司或機構名稱 Tel. No. 電話號碼 Fax No. 傳真號碼 Mobile Phone o. 流動電話號碼 Email Address 電郵地址 * Please see item 5 of Notes for Applicant 請參閱 Building Information 建築物資料 Name of Building 建築物名稱 English英文 Chinese中文 Address of Building 建築物地址 English英文 Chinese中文 Electricity onsumption of the Building 建築物的用電量 Electricity consumption in the communal areas for the past 12 months公用地方過去12個月的用電量 度電 kWh Please provide relevant documentary proof if available 請提交相關的證明文件 Type of Building 建築物類別 commercial 商業 residential 住宅 industrial 工業 composite building please specify the components:__________ 綜合樓宇 請註明組成部分:__________________________ _ Amount of Grant Requested 申請資助總額 HK$ Cheque Payable to 支票抬頭人/機構 閱Declaration 聲明 I certify that 本人謹此聲明 – all activities seeking grant of fund are non-profit-making and will not be used for political, religious or commercial purposes for any individual or organization;所有申請資助的活動均屬非牟利性質，且非為個人或團體作政治、宗教或商業宣傳之用； the information provided in this form is correct to the best of my knowledge; and據本人所知，本表格內填報的資料均正確無訛；及 understand and agree to abide by the terms and conditions as set out in the “Guide To Application” and will comply with all the requirements laid down in the Agreement should the applicant be granted fund for the project. 申請機構明白並同意遵守《申請指引》所列之條款；如獲基金資助，機構會遵守協議書所列的各項規定。 Signature 簽署