出口许可证申请表渔农自然护理署.docVIP

出口/再出口許可證申請表 此欄由辦理機關填寫For official use only EL RL 香港法例586章保護瀕危動植物物種條例 動物標本Animal specimens □ Application for a LICENCE TO EXPORT/RE-EXPORT 植物標本Plant specimens □ Protection of Endangered Species of Animals and Plants Ordinance, Cap. 586 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: …………… 電郵地址 E-mail Address ………………………………………………………………….. 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) 5. 如源自香港的標本上有標記，則有關出口許可證須註明該標記的編號。請用附加紙張提供有關標記編號。 If specimens are originated from Hong Kong and are marked, the numbers of the marks appearing on the specimens shall be indicated on the related export licence. Please use additional page to provide numbers of the marks. 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.__ 6. (a) 獲得物品的日期 The specimen was acquired on： (date) (b) 進口許可證號碼 Licence to Import No.：APO/IL (c) 管有許可證號碼 Licence to Possess No.：APO/PL (d) 扣除本出口許可證的使用量後，該物種貨品的存量: Stock balance of specimens after deduction by this Export Licence:. (e) 本出口許可證所扣除的物種貨品數量: Quantity of specimens deducted by this Export Licence: 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 (請參考附加的注意事項） CITES # Appendix No. (I, II or III) and source (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. 來源地、公約# 准許證編號及日期 C