Trade and Industry Department Saleable Form (for viewing only)

Exporter (Name & Address)

Business
Reg. No. Tel. No.

Licence No. Date of Issue

Fee

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

Consignee (Name and Address)

EXPORTER'S DECLARATION

Date..........................................

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

hereby declare that I am the exporter of the goods in respect of which
this declaration is made and that the particulars given herein are true.
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

Registration No. under the Ozone Layer Protection Ordinance

Country of Final
Destination

Intended Date
of Departure

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

FOB
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

For Official Use Only

Issue of this licences is approved

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