人类尸体进口申请书ApplicationfortheImportofaHumanCorpse.pdf

香港特別行政區政府衞生署 Department of Health The Government of the Hong Kong Special Administrative Region 人 類 屍 體 進 口 申 請 書 Application for the Import of a Human Corpse 本人根據《預防及控制疾病規例》(第599A 章) 擬申請人類屍體進口許可證，以便將下述屍體運載來港安葬/火化 。 I, in accordance with the Prevention and Control of Disease Regulation (Cap. 599A), wish to apply for a permit to import the human corpse described below for the purpose of interment/cremation. 1. 申請者資料 Particulars of the Applicant: 申請者姓名: 身份證 / 護照號碼: Name of applicant: Identity card / Passport no.: 公司名稱 (如適用): Name of company (if applicable): 地址: Address: 電話: 傳真: 與死者關係: ☐ 代理人* ☐ 家屬 ☐ 朋友 Tel.: Fax: Relationship with the deceased: Agent* Family Friend *如申請者為代理人，請註明委託人的以下資料: * If the applicant is an agent, please specify the particulars of the authorising party below: 委託人姓名: 與死者關係: Name of authorising party: Relationship with the deceased: 2. 死者資料 Particulars of the Deceased: 姓名: 性別: 出生日期: Name: Sex: Date of birth: (DD 日/ MM 月/ YY 年) 國籍: 身份證 / 護照號碼: Nationality: Identity card/ Passport no.: 最後所知地址: Last known address: 職業: 死亡地點: 死亡日期: Occupation: Place of death: