村代表选举（原居民代表）.PDFVIP

IIR 村代表選舉(原居民代表) 選民登記／更改登記資料申請表 檔案編號 Application Reference No 原居民代表 Village Representative Election – Indigenous Inhabitant Representative Application for Voter Registration / Report on Change of Registered Particulars 注意: 請用正楷填寫本表格，填寫前請參閱填表須知。任何人士如明知或罔顧實情地作出任何在要項上屬虛假或不正確的陳述，或略去任何要項，即屬違法。 IMPORTANT: Please read the accompanying guidance notes before completing this form in BLOCK LETTERS. A person who knowingly or recklessly makes any statement which is materially false or incorrect or knowingly omits any material particular commits an offence under the law. 1a. 香港身分證號碼 英文字母 Prefix 號碼 Number 核對號碼 Check Digit 2. 性別 男Male 女Female HK IDENTITY CARD NUMBER ( ) SEX 1b. 身分證明文件 [須知4] (如沒有香港身分證) [請夾附有關身分證明文件副本] IDENTITY DOCUMENT (Note 4) (If you do not have a Hong Kong Identity Card) (Please attach a copy of such identity document) 證件類別 Document Type 號碼 Number 簽發機構 Issuing Authority 3. 香港身分證／身分證明文件所載的資料 INFORMATION AS SHOWN ON THE HK IDENTITY CARD / IDENTITY DOCUMENT 中文姓名 Name in Chinese 電碼 in Chinese Commercial Code 姓(英文) Surname 名(英文) Other Names in Full 出生日期( 日／月／年) Date of Birth (dd / mm / yyyy) 4. 主要住址 [須知 10] 。請用中文正楷或英文大楷填寫本欄 。 PRINCIPAL RESIDENTIAL ADDRESS (Note 10). Please complete in CHINESE or in ENGLISH Block Letters. 單位／室 樓 座 屋苑／樓宇名稱 Flat / Room Floor Block Name of Estate / Building 門牌 鄉村名稱 House No.