香港法例第207章植物( 進口管制及病蟲害控制 )條例
進口種植材料申請表
Plant ( Importation and Pest Control) Ordinance, Chapter 207
Form of Application for Import of Growing Medium

　
注意事項：
  Notes　　　　    	1.	此表格最好以英文正楷填寫。
Appreciated if this form could be completed in English and in block letters.	
	2.	請看背頁的個人資料收集聲明。
Please see overleaf for Personal Information Collection Statement.	
	3.	如有關填寫此申請表上的問題，請致電(852)2150 7000與本署植物及除害劑監理科聯絡。
For any enquiries on filling this form, please contact Plant & Pesticides Regulatory Division at (852) 2150 7000.	
	4.	領取授權書方法：
Method of Authorization Collection :	
		  本辦事處2號櫃位。
  Over the Counter No.2 of this office.	
		  郵寄（惟申請時須連同有地址及郵票之回郵信封）。
  By mail (Please provide a self-addressed envelope with stamp during application.)	

申請人姓名Name of Applicant:                                	身分証號碼:         - - -	       
* 先生Mr. / 小姐Miss/ 女士Ms.                              	H.K.ID Number
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:    ________           
Email									             		    Telephone No.

申請入口種植材料的種類及數量:
Type and Quantity of Growing Medium to be imported:

種植材料種類 (請填寫組成成份的方程式，如適用；即每種成份之容量或重量的比例，
例如：泥炭土/珍珠石，容量比為5:1 )
Type of Growing Medium (with formulation of composition if applicable, i.e. the relative proportion of each component on a volume or weight basis, e.g. peat/perlite, 5:1, v/v)	數量Quantity
(公斤 kg)	

		
                                                    總數Total :		

出口公司名稱:                                                                                   
Name of exporter 
來源地:                                            	進口目的:                                             
Source/Origin	                            			Purpose of Importation
運輸工具:                                           	預計抵港日期:                                
Means of Conveyance								Expected Date of Arrival
申請日期:                                         	申請人簽署:                                  
Date of Application							   	Signature of Applicant

* 請將不適用者刪去 Delete as appropriate
此欄由本署填寫For Official Use Only
File Ref. Of Auth.	Auth. No.	Prepared By	Checked By	
 (    ) in AF PPR 11/5 Pt (   )				

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 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.	
	本人已申報進口種植材料的種類、成份及數量。
I have already provided the type(s), formulation(s) of composition and quantity(ies) of growing medium to be imported.	
	本人已提供該批種植材料的來源地及出口公司名稱。
I have already provided the origin and name of exporter of the growing medium to be imported.	
	本人已提供該批種植材料的預計抵港日期。
I have already provided the expected date of arrival of the consignment of growing medium.	
	本人已在申請表上簽署。
I have already signed my name on the application form.