Form Id 990a - Application For Employment As Professionals In Hong Kong Page 4

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7. 申請人的聲明 Declaration of Applicant

本人向香港特別行政區入境事務處遞交本申請，謹此作出以下聲明：

In submitting this application to the Immigration Department of the Hong Kong Special Administrative Region (HKSAR), I declare the following:

本人從沒有更改姓名。

(i)

(a)

I have not changed my name before.

本人曾經更改姓名。曾用的姓名如下：

I have changed my name and used the following name(s) before:

本人從未被拒絕入境／遞解／遣送或要求離開香港。

(b)

I have never been refused entry into, deported from, removed from or required to leave Hong Kong.

本人曾被拒絕入境／遞解／遣送或要求離開香港。有關的日期及詳細資料如下：

I have previously been refused entry into, deported from, removed from or required to leave Hong Kong. The date(s) and details are as follows:

本人從未被拒絕簽發簽證／進入許可以入境香港。

(c)

I have never been refused a visa/entry permit for entry into Hong Kong.

本人曾被拒絕簽發簽證／進入許可以入境香港。有關的日期及詳細資料如下：

I have previously been refused a visa/entry permit for entry into Hong Kong. The date(s) and details are as follows:

(ii) 本人同意為處理本申請個案而進行任何所需的查詢。

I consent to the making of any enquiries necessary for the processing of this application.

(iii) 本人同意為處理本申請個案而向任何機構或政府機關（包括在香港特別行政區境內或境外的）提供本人的資料。

I consent to releasing my information to any organisations and authorities, including those inside or outside the HKSAR, for the processing of this application.

(iv) 本人授權所有私營及公營機構（包括在香港特別行政區境內或境外的）向香港特別行政區入境事務處提供為處理本申請個案所需的任何記

錄或資料。

I authorise all private and public organisations, including those inside or outside the HKSAR, to release any record or information which the Immigration Department

of the HKSAR may require for the processing of this application.

(v) 本人同意可將本申請表內各項資料提供予各政府部門 (包括稅務局 )及其他在香港特別行政區境內或境外的公、私營機構 (包括強制性公積金

計劃管理局 )以作核對用途。

I consent to the use/disclosure of any information herein by/to any government bureaux, departments (including the Inland Revenue Department) and any other private

or public organisations inside or outside the HKSAR (including the Mandatory Provident Fund Schemes Authority) for verification purposes.

(vi) 本人明白任何人為本申請的目的而言，明知而故意申報失實或填報其明知為虛假或不相信為真實的資料，根據香港法例即屬違法，可被檢

控及於其後被遣離香港。本申請可被拒絶，而任何已向申請人及受養人簽發、或已審核批准簽發的入境簽證／進入許可／延期逗留，或任

何已施加於申請人及受養人的逗留條件，均可被宣告為無效。

I understand that any person who knowingly and wilfully makes a statement or gives information which he/she knows to be false or does not believe to be true for the

purpose of this application shall be guilty of an offence under the Laws of Hong Kong and is liable to prosecution and subsequent removal from Hong Kong. This

application may be refused, and that any visa/entry permit/extension of stay so granted or issued to the applicant and his/her dependants and any conditions of stay so

imposed on him/her and his/her dependants may become null and void.

(vii) 本人明白如獲批准根據「一般就業政策」或「輸入內地人才計劃」在港受僱，本人只可從事經批准的僱傭工作。除非事先獲得入境事務處

的批准，否則不能轉換工作。

I understand that the permission given to me to remain in Hong Kong for employment under the ‘General Employment Policy’ or ‘Admission Scheme for Mainland

Talents and Professionals’ will be subject to the condition that I shall only engage in such employment as may be approved. Change of employment is normally not

allowed unless prior permission is obtained from the Immigration Department.

(viii) ^ 本人代表本部第

項內的所有隨行受養人遞交以本人的受養人身份來港居留的申請。有關申請載於本申請表乙部。本人承諾擔任本申請

表內各受養人的保證人，負責在其獲准逗留香港期間的一切費用及開支。本人亦承諾倘受養人在入境事務處處長所批准的逗留期限屆滿時

。

仍未離港，本人願意承擔責任，將受養人遣返 ( 填上原居地 )

^I submit on behalf of all the accompanying dependant(s) of item 3 in this Part their application(s) for residence in Hong Kong as my dependant(s) which are set out in

Part B of this application form. I undertake that I will be the sponsor responsible for all the expenses and expenditure of the accompanying dependant(s) of this

application while he/she is allowed to remain in Hong Kong.

I also undertake to assume responsibility for the dependant(s)’ repatriation to (place of

domicile)

if at the expiry of limit of stay granted by the Director of Immigration, the accompanying dependant(s) fails to leave

Hong Kong.

(ix)

如本人的進入許可獲得批准，本人將會向內地有關部門申辦因私往來港澳通行證（通行證）及有關的赴港簽注以來港就業 / 居留。本人

明白本人來港前應把發給本人的進入許可標籤貼在具有相關赴港簽注的通行證上，才可來港就業 / 居留。倘若本人持有具相關赴港簽注的

通行證為電子通行證，則須於辦理入境手續時一併出示簽發予本人的進入許可標籤。如本人持其他旅行證件，本人將會被拒入境。

Should this application for an entry permit be successful, I will apply for an Exit-entry Permit for Travelling to and from Hong Kong and Macao (EEP) and the relevant

exit permission from the relevant Mainland authorities for travelling to Hong Kong to take up employment/residence. I understand that an entry permit granted to me is

to be affixed onto an EEP with the relevant exit permission prior to my arrival in Hong Kong for employment/residence. In case my EEP bearing the relevant exit

permission is an electronic EEP, I should present it together with the entry permit granted to me for immigration arrival clearance. Should I enter Hong Kong on other

travel document, I will be refused entry to Hong Kong.

(x) 就本人所知所信，本申請表內甲部所塡報的所有資料均為正確、完備和真實。

All information given in Part A of this application form is correct, complete and true to the best of my knowledge and belief.

申請人簽署

日期

Signature of applicant

Date

^ 只適用於在申請表內列有受養人的申請人。請將不適用者删去。

注意:

Note:

^ Only applicable to applicants who have accompanying dependants in the application.

Please delete where inappropriate.

只適用於內地的中國居民，包括現時暫居於香港和澳門的內地居民申請進入香港就業／居留。請將不適用者删去。

Only applicable to the Chinese residents of the Mainland including those who are currently residing in Hong Kong or Macao on a temporary basis, and who

are applying for entry to Hong Kong for employment/residence.

Please delete where inappropriate.

(5/2014)