香港宽减计划申请1.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 登記申請表格 Application Form for Registration 請把表格遞交到香港灣仔告士打道5號稅務大樓33樓環境保護署空氣政策課(5) Please send this form to Air Policy Section (5), Environmental Protection Department, 33/F, Revenue Tower, 5 Gloucester Road, Wan Chai, Hong Kong. 申請人資料Particulars of the Applicant 聯絡人Contact Person 船東 / 船隻營運商名稱 / 船隻代理人名稱* Name of Shipowner / Vessel Operator / Shipping Agent * 電話Telephone 傳真Fax 電郵Email 通訊地址Address: *請將不適用的刪去Delete where inapplicable 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 國際海事組織編號IMO Number To: Director of Environmental Protection (the ‘Director’) on behalf of the HKSAR Government (the ‘Government’) 致: 環境保護署署長 (署長) 代表香港特別行政區政府 (政府) 1. 我/我們現為以上船隻申請登記參與港口設施及燈標費寬減計劃(寬減計劃)。為申請此寬減計劃內的減免，我/我們明白此船隻在登記後，在每次停靠香港時，必須提交兩份由船長簽署的聲明及其他所需文件，證明船隻在香港停泊時使用含硫量不逾0.5%的燃油。 I/We hereby apply to register the above vessel (the ‘Vessel’) for joining the Port Facilities and Light Dues Incentive Scheme (the ‘Incentive Scheme’). To apply for a grant of Concession under the Incentive Scheme, I/We understand that the Vessel after registration will have to submit two declaration forms signed by the shipmaster, for every port call to Hong Kong, which indicate the use of fuel with sulphur content not more than 0.5% while at berth in Hong Kong. 2. 就登記以上船隻在此寬減計劃內: 我/我們明白任何政府人員或會登船查核任何有關泊岸轉用低硫燃油的文件，及/或抽取燃油樣本，以核實任何有關申請或給予寬減計劃內的減免之用。 我/我們在任何情況下，若政府取消此船隻在寬減計劃內的減免，我/我們明白此船隻須於自取消日起計14天內，向政府繳交全數應繳港口設施及燈標費。 我/我們確認已閱讀「重要事項」及理解其中的含義 In consideration of your registering the Vessel under the Incentive Scheme, I/we understand that any Government official may board the Vessel to inspect any document reasonably required and/or take fuel oil samples for the purpose of verification of any matter relevant to