香港法例第207章《植物（進口管制及病蟲害控制）條例》
申請進口植物
Plant ( Importation and Pest Control ) Ordinance, Chapter 207 of the Laws of Hong Kong
Form of Application for Plant Import

注意事項：
Note	1. 請儘量以英文正楷填寫此表格。
Please complete this form in English and block letters as far as possible.	5. 領取進口證方法：
Method of Licence Collection :	
	2. * 請將不適用者刪去。Delete as appropriate.	□ 本辦事處2號櫃位。
Over the Counter No.2 of this
Office.
□ 郵寄（申請時須提供附有地址及郵票之回郵信封）。
By mail (Please provide a
self-addressed envelope with stamp.)
□	電郵。
Email.
	
	3. 如有關填寫此申請表的問題，請致電(852) 2150 7000與漁農自然護理署植物及除害劑監理科聯絡。可親身到本辦事處(九龍長沙灣道303號長沙灣政府合署五樓)遞交填妥的申請表，傳真至(852) 2314 2622，電郵至plantlic@afcd.gov.hk或郵寄至本辦事處。
For any enquiries on filling in this form, please contact the Plant & Pesticides
Regulatory Division at (852) 2150 7000.  Completed application form(s) can be
handed to this Office (5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha
Wan Road, Kowloon), by fax to (852) 2314 2622, e-mail plantlic@afcd.gov.hk or mail.		
	4. 請看背頁的個人資料收集聲明。
Please see overleaf for Personal Information Collection Statement.		

申請人姓名Name of Applicant:                                                                               
* 先生Mr. / 小姐Miss/ 女士Ms.                              	
公司名稱:                                                 	商業登記証號碼:           	 			
Name of Company			   				BRC Number
地址:                                                       										
Address
電郵:                                                      	電話號碼:     		          			 
E-mail									             	Telephone No.

申請入口植物的名稱及數量Name and Quantity of Plants to be Imported:
植物學名
Botanical Name	植物俗名
Common Name	公約#附錄編號
CITES# Appendix No.	來源Source	數量
Quantity	
			人工培植
Artificially propagated	野生
Wild		
		*I / II / III / 非公約Non-CITES	□	□		
		*I / II / III / 非公約Non-CITES	□	□		
		*I / II / III / 非公約Non-CITES	□	□		
		*I / II / III / 非公約Non-CITES	□	□		
		總數Total:		
入口植物是否附有種植材料? * 是 / 否 (如有，請說明它的種類:                )
Are plants imported with growing medium? * Yes / No  ( If Yes, please specify its type:                           )

來源地及出口公司名稱:                         		   			  	進口目的: _______________________
Origin and Name of Exporter                          		  			Purpose of Importation
運輸工具:                                        				  	預計抵港日期: ___________________
Means of Conveyance				               		  			Expected Date of Arrival

聲明：     	本人聲明上述植物包含瀕危植物品種。                                * 是Yes / 否No 
Declaration : 	I declare that the above plant (s) contain(s) scheduled endangered plant species.

□本人明白進口瀕危植物必須附有進/出口地區有關部門簽發的瀕危植物品種文件。本人可致電(852) 2150 6974或傳真(852) 2376 3749向漁農自然護理署瀕危物種保護科查詢詳情。
I understand that import of any scheduled endangered plants shall be covered by CITES documents issued by a competent authority of the exporting /and importing places. I shall contact the Endangered Species Protection Division of AFCD at Tel. (852) 2150 6974 or Fax (852) 2376 3749 for details. 

申請日期Date of Application: ______________________   申請人簽署Signature of Applicant:                  	   
#公約/CITES=瀕危野生動植物種國際貿易公約/The Convention on International Trade in Endangered Species of Wild Fauna and Flora

此欄由本署填寫For Official Use Only

	PIL No./Auth. Ref.	Prepared by	Checked by	Remarks	

香港漁農自然護理署		AGRICULTURE, FISHERIES            
       AND CONSERVATION DEPARTMENT
       OF HONG KONG 
	
個人資料收集聲明		Personal Information Collection Statement	
��	你所提供的資料將用作申請本署的植物進口證、授權書或植物檢疫證明書的有關事宜。		��	The information provided by you will be used for purposes relating to the application for plant import licence, authorization or phytosanitary certificate in this Department.	
��	本署可能會將你的資料或部份資料提供給本署的瀕危物種保護科、任何代理商、承包商或其他政府部門作統計或調查之用途。		��	The said information or any part thereof may be supplied by this Department to Endangered Species Protection Division of AFCD, any agent, contractor or other government departments for statistics or investigation purpose.	
��	除個人資料(私隱)條例所訂明的豁免外，你有權查閱和改正你的個人資料。		��	Subject to exemptions under the Personal Data (Privacy) Ordinance, you have a right of access and correction with respect to personal data.	
��	查閱和改正個人資料的要求應以書面形式向漁農自然護理署署長提出，地址為香港九龍長沙灣道三零三號長沙灣政府合署五樓，同時請註明你在本署的檔案號碼。		��	Request for personal data access and correction should be addressed to Director of Agriculture, Fisheries and Conservation at 5/F., Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon, Hong Kong.  Please also quote your reference number in this Department.	

Checklist for information provided by the applicant
申請人資料遞交核對表
	本人已填寫個人/公司資料。
I have already filled in my personal particulars / company details.	
	本人已申報進口的植物學名及其數量。
I have already provided the botanical name(s) and quantity(ies) of the plant(s) to be imported.	
	本人已申報該批植物是否附有種植材料及其種頪。
I have already specified the type of growing medium for the consignment of plant(s), if any.	
	本人已提供該批植物的來源地及出口公司名稱。
I have already provided the origin and name of exporter of the plant(s) to be imported.	
	本人已提供該批植物貨件的預計抵港日期。
I have already provided the expected date of arrival of the consignment of plant(s).	
	本人已聲明該批植物貨件是否包含瀕危植物品種。
I have already declared whether the consignment of plant(s) contain scheduled endangered plant species or not.	
	本人已在申請表上簽署。
I have already signed my name on the application form.