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FSD Ref. 消防處檔號 : Contractor Ref. 承建商檔號 : Annual Inspection Certificate 年檢證書 Building Ventilating Systems Regulations 建築物（通風系統）規例 Address of Premises Inspected : 經視察處所的地址 : footnote i 註腳 Premises Type : 處所類別 : footnote ii 註腳 I have inspected every damper, filter and precipitator that are present in the ventilating system s of the above premises on ______ completion date of inspection . In accordance with the Regulation 5A of the Building Ventilating Systems Regulations, Cap. 123J, Laws of Hong Kong, I certify that all dampers / filters / precipitators delete where inappropriate , except those specified below, are in safe and efficient working order :- 本人已於 ________ 完成檢查日期 檢查上述處所通風系統內的每個防火閘、過濾器及聚塵器。現根據香港法例第123J章《 建築物（通風系統）規例 》第5A條，本人確證除下列裝置外，所有防火閘 / 過濾器 / 聚塵器（删除不適用者）均處於安全和有效的操作狀態。 Defects observed : 存在缺點 : footnote iii 註腳 Exclusion from inspection : 未包括之檢查項目 : footnote iv 註腳 Name of Registered Specialist Contractor Ventilation Works Category : 註冊專門承建商 通風系統工程類別）的名稱 : Chop of Registered Specialist Contractor Ventilation Works Category : 註冊專門承建商 通風系統工程類別）的蓋章 : Address and Contact Telephone of Registered Specialist Contractor Ventilation Works Category : 註冊專門承建商 通風系統工程類別）的註冊地址及聯絡電話 : Registration Number under Buildings Ordinance of Registered Specialist Contractor Ventilation Works Category : 根據《 建築物條例 》之註冊專門承建商 通風系統工程類別）的註冊編號 : SC V Signature of Authorised Signatory AS 授權人士簽署 Date of Certificate Issue : 證明書發出日期 : Full Name of AS in BLOCK letters 授權人士 姓名 For building, an individual certificate shall be used for each building block or complex. DO NOT just give the name of a development or the lot number. For licensed premises, the address indicated on the licence shall be used. 必須就每座樓宇或商場個別發出證明書 ，切勿只提供物業發展名稱或地段號碼。但凡牌照處所，必須根據牌照上顯示的地址。 Building or other type as indicated on licence 樓宇或牌照上顯示之其他類別 Apparatus type, location and brief account of defect have to be given. Use supplementary sheet if necessary 說明裝置類型、位置及簡要評述缺點狀况，有需要時可加