Title: 進口/管有許可證申請表_
Author: Hong Kong Government
Last saved by: ESPD

進口/管有許可證申請表 | 此欄由辦理機關填寫 For official use only
IL
PL
香港法例第187章動植物（瀕危物種保護）條例 | 活生動物Live animals | □
Application for a LICENCE TO IMPORT/POSSESS | 植物Plants | □
Animals and Plants (Protection of Endangered Species) Ordinance, Cap. 187 | 其他Others | □
填寫此申請表前請先詳閱背頁內容Please read the notes overleaf before filling in this application form
1. 申請人姓名及地址Applicant‘s Name & Address | 2. 供應商姓名及地址Supplier‘s Name & Address
聯絡人姓名 |
Contact Person‘s Name: .................................................………........................... |

電話                     傳真
Telephone No. : .............................................Fax :………………………………

3. 存放地址Address of keeping premises

4. (a) 用途：售賣/私人物品/其他（請說明）
Purpose : Trade/Personal/Others (Please specify)

| ......................................................................................................................

(b) 預期物品的抵港日期/獲取該物品的日期
Expected date of arrival/acquisition

| ......................................................................................................................

(c) 運輸方法：空運/船運/火車/貨車/其他（請說明）
Transportation : By Air/Ship/Train/Truck/Others (Please specify)

| ......................................................................................................................

5. (a) (i) 申請人的香港商業登記證號碼
Applicant‘s H.K. Business Registration No. .........................................

6. （適用於申請管有在香港獲取的物品）
(For application for a licence to possess specimens acquired in Hong Kong)

(ii) 身分證/護照號碼
Identity Card/Passport No. ....................................................................

該物品是根據下列證件進口/管有：
The specimens were previously imported/possessed under

或
or

(a) 進口許可證號碼 ： APO/IL ...........................................................
Licence to Import No.

(b) 漁農自然護理署動物售賣商牌照號碼
AFCD Animal Trader Licence No. ..............................................................

(b) 管有許可證號碼 ： APO/PL ..........................................................
Licence to Possess No.

7. 動/植物的物種Species of animal/plant
(a) 學名（拉丁文名稱）
Scientific Name

8. 瀕危物種公約# 附錄編號（Ⅰ、Ⅱ或Ⅲ）及來源（W、C、或A）* CITES # Appendix No. (I, II or III) and Source (W, C or A)*

9. 物品種類（如活生、毛皮、象牙或根等）Description of specimens (e.g. live, skin, ivory tusk or root)

10. 數量：數目 (頭/件)、淨重 (公斤)、面積 (平方公尺)等Quantity : number (head/pc), net weight (kg), area (m^2), etc.

(b) 俗名Common Name | | |
| *W:野外獲得Wild | |
| C:人工繁殖Captive-bred | |
| A:人工培植Artificially-propagated | |
11. 產地來源國及瀕危物種公約許可證編號Country of Origin & CITES Permit No. | 簽發日期       Date of Issue | 12. 出口國及瀕危物種公約許可證編號Country of Export & CITES Permit No. | 簽發日期        Date of Issue
本人已閱畢背頁的應注意事項及警告，並聲明上面各項填報詳情均為正確無訛。本人明白必須完全遵守證上所列各項條款，獲發的許可證方為有效，而證上所列的有關物品，進口時須經由漁農自然護理署授權職員檢查。I have read the notes and warning overleaf and I declare that all the particulars given above are true and correct. I understand that any licence, if issued, is valid only when all the licence conditions stipulated on the licence are fully complied with and that the specimens must be inspected by an authorized officer of the Agriculture, Fisheries and Conservation Department upon importation.
申請人簽署Signature of Applicant : | |
............................................................................. | （公司印鑑Company chop） | 日期Date : ...............................................
此欄由辦理機關填寫For official use only
Date Received | Remarks/Additional Information | Licence prepared :
| | APO/IL ........................................................
| | APO/PL .......................................................
| | Date : ...........................................................
| | By :
| | ............................................................
 AFCD : 漁農自然護理署Agriculture, Fisheries and Conservation Department
#瀕危物種公約=瀕危野生動植物種國際貿易公約CITES : Convention on International Trade in Endangered Species of Wild Fauna and Flora
AF 243 (Rev. 2/2000) W

申請人注意事項
(1)	所有資料必須以英文正楷填寫或以打字機打印。
(2)	每樣物種及每批動、植物/物品均須分開申請。
(3)	在遞交申請表時，必須附上有關證明文件的影印本（瀕危物種公約出口許可證或供應商持有的管有許可證   （適用於申請管有許可證）、發票等）。
(4)	本署通常需三個工作天處理每份申請，但倘若申請表上的資料填報不齊或欠缺所需文件，處理將會有所延誤。
(5)	本署簽發許可證須收取有關費用。
(6)	遞交申請表：（1）	郵寄至九龍長沙灣道303號長沙灣政府合署五樓漁農自然護理署瀕危物種保護
		(牌照事務組)科，或
（2）	傳真至 2376 3749。
(7)	如有查詢，請致電 2150 6999/2150 6973，或傳真 2376 3749。

NOTES TO APPLICANT
(1)	Information should be written or typed in BLOCK LETTERS in English.
(2)	A separate application should be made for each species and for each consignment.
(3)	Photocopies of all supporting documents (CITES Export Permit or supplier‘s H.K. Licence to Possess (if it is an application for Licence to Possess), invoices, etc.) should be submitted with the application.
(4)	Normally 3 working days will be required for processing an application. However, delays may be resulted if the application is incomplete or lacks supporting documents.
(5)	Appropriate fee will be charged for the issue of a licence.
(6)	Application can be submitted by :	(1)	mail to Endangered Species Protection (Licensing Section) Division, Agriculture, Fisheries and
		Conservation Department, 5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, 
		Kowloon, or 
	(2)	fax to 2376 3749.
(7)	For enquires, please call 2150 6999/2150 6973 or fax 2376 3749.

個人資料收集聲明
��	你所提供的資料將用作與申請本署的瀕危物種公約許可證的有關事宜。
��	本署可能會將你的資料的任何部分提供給予其他政府部門、海外瀕危物種管理機構或公約秘書處作為調查或 統計之用途。
��	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。
��	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瀕危物種保護(牌照事務組)科提出，地址為九龍 長沙灣道303號長沙灣政府合署五樓，電話：2150 6999/2150 6973，同時請註明你在本署的檔案號碼。

PERSONAL INFORMATION COLLECTION STATEMENT
��	The information provided by you will be used for the purposes relating to the application for CITES licences in this department.
��	The said information of any part thereof may be supplied by this department to other government departments, overseas CITES Management Authorities or CITES Secretariat for investigation or statistics purposes.
��	Subject to exemptions under the Personal Data (Privacy) Ordinance, you have a right of access and correction with respect to personal data.
��	Request for personal data access and correction should be addressed to Endangered Species Protection (Licensing Section) Division of Agriculture, Fisheries and Conservation Department at 5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon.
Telephone: 2150 6999/2150 6973. Please also quote your reference number in this department.

警告
1.	許可證是不會自動獲得簽發的，本署亦可拒絕任何申請。申請人除非已領有許可證，否則切勿進口/管有有關法例附表所列的物種。違例人士可能會被檢控、罰款，而有關的物種可能會被充公。
1.	倘若漁農自然護理署署長認為申請人由於虛報任何事實或作出不法行為而導致獲簽發某許可證，則可隨時將該證註銷。

WARNING
1.	The issue of a licence is NOT automatic and application may be refused. Applicant SHOULD NOT import/possess any scheduled species unless and until a licence has been granted. Failure to observe this may lead to prosecution, fine and forfeiture of the species concerned.
1.	The Director of Agriculture, Fisheries and Conservation may at any time cancel a licence if the Director is satisfied that the licence was issued as a result of false presentation of any fact or unlawful act of the applicant.