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

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 。

EXPORT LICENCE FORM                                        ORIGINAL
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

COPYRIGHT RESERVED