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Trade and Industry Department The Government of the Hong Kong Special Administrative Region
Brand Hong Kong - Asia world city
MY COLOUR

This sample saleable form is for reference only.   Downloading this form for submission will not be accepted.
此 樣 本 表 格 僅 供 參 考 ，不 能 下 載 用 作 遞 交 之 用 。

IMPORT LICENCE FORM ORIGINAL

Foreign Exporter (Name & Address)

Licence No.                                      Date of Issue

Fee

THE GOVERNMENT OF THE HONG KONG
SPECIAL ADMINISTRATIVE REGION
Ozone Layer Protection Ordinance

Importer (Name and Address)




Business
Reg. No.          Tel. No.		 Storage Address (if different from Importer's address)

　

　


Tel. No. :  ...........................................

Registration No. under the Ozone Layer Protection Ordinance Exporting
Country
Intended Date
of Arrival
Vessel/Flight/
Vehicle No.
FOR CONDITIONS OF ISSUE PLEASE SEE OVERLEAF    Warning: All alterations must be carried out by authorized officers. Heavy penalties are provided for false declaration and information, unauthorized alternations and misuse of this licence.
Item
No.


Marks &
Number

(1)

 No. & Kinds
of Packages

(2)

 Country
of
Origin

(3)

 Full Description
of Goods including
Brand Names

(4)

 Net Weight
of Goods
in Kg
(See
overleaf)

(5)

Schedule Substances contained
in the goods		 CIF
Value
HK$

(9)

Common
Name (See
overleaf)

(6)

 Percentage
by weight
(7)
 Weight
Quantity
in Kg
(8)=(5)x(7)xODP
(See overleaf)
Total Kg Total
Amount
IMPORTER'S DECLARATION

Date ........................ 

       I, ............................................................
Authorized Official of .............................................
                          (Name of Importer)        

hereby declare that I am the importer of the goods in respect of which this application is made and that the particulars given herein are true. I further declare that the goods imported shall be as described and care for (a)* local consumption (b)* re-export. [Delete (a) or (b) where not applicable]
I declare the goods in Item No. (   ) are **new/recovered/reclaimed for **feedstock/exempted essential uses/quarantine & pre-shipment applications/other usage.
** delete as appropriate

.............................................    .............................................
                Signature                            Company Chop

 For Official Use Only Issue of this licences is approved

　



........................................................
for Director of Environmental
Protection

COPYRIGHT RESERVED