Form Id 990a - Application For Employment As Professionals In Hong Kong Page 6

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乙部 Part B: 申請以受養人身份來港居留

Application for Residence as Dependants

(if applicable)

(如適用 )

(兒童受養

本表格甲部第 3 項的所有隨

行

受養人均須個別填寫本部分，

如有需要，請影印或從互聯網額外下載本頁繼續填寫。 16 歲以下的

受

養

人

人 )

須

由

其父

、

母或合法監護

署。

All accompanying dependants in item 3 of Part A of this application form are required to complete this Part individually. Please continue to complete on a

photocopy or an additional downloaded copy of this page if necessary. If the dependant is a child under the age of 16, (child dependant), this application should

be signed by his/her parent/legal guardian.

1. 受養人

(

) #

Dependant (

) #

(

請填寫相符本申請表甲部第 3 項給予有關受養人的編號。 Please fill in the serial number which corresponds to the number assigned to the dependant in

item 3 of Part A in this application form)

姓名 (中文 )

(如適用 )

( 如適用 )

婚前姓氏

Name in Chinese

Maiden name

(if applicable)

姓 ( 英文 )

Surname in English

名 (英文 )

Given names in English

Declaration of Dependant/Parent/Legal Guardian

受養人／父／母／合法監護人的聲明

本人向香港特別行政區入境事務處遞交本申請以受養人身份來港居留，謹此作出以下聲明：

In submitting this application for residence as a dependant to the Immigration Department of the Hong Kong Special Administrative Region (HKSAR), I

declare the following:

*本人╱兒童受養人從沒有更改姓名。

(i)

(a)

*I/The child dependant have/has not changed my/his/her name before.

*本人╱兒童受養人曾經更改姓名。曾用的姓名如下：

*I/The child dependant have/has changed my/his/her name and used the following name(s) before:

*本人╱兒童受養人從未被拒絕入境 ╱遞解 ╱遣送或要求離開香港。

(b)

*I/The child dependant have/has never been refused entry into, deported from, removed from or required to leave Hong Kong.

*本人╱兒童受養人曾被拒絕入境／遞解／遣送或要求離開香港。有關的日期及詳細資料如下：

*I/The child dependant have/has 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╱ 兒童受養人從未被拒絕簽發簽證／進入許可以入境香港。

(c)

*I/The child dependant have/has never been refused a visa/entry permit for entry into Hong Kong.

*本人╱兒童受養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/The child dependant have/has previously been refused a visa/entry permit for entry into Hong Kong. The date(s) and details are as follows:

(ii)

向香港特別行政區入境事務處代*本人／兒童受養人遞交本

本人授權 ( 保證人姓名-本申請表甲部的申請人)

申請。

I authorise (sponsor’s name - applicant of Part A in this application form)

to submit this application to

the Immigration Department of the HKSAR for *me /the child dependant.

(iii) 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.

(iv) 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／兒童受養人的資料。

I consent to releasing m

* y/the child dependant’s information to any organisations and authorities, including those inside or outside the HKSAR, for the processing of this

application.

(v)

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.

(vi) 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.

(vii)

如 *本人╱兒童受養人的進入許可獲得批准，*本人╱兒童受養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

居留。本人明白 *本人╱兒童受養人來港前應把發給 *

本人╱兒童受養人的進入許可標籤貼在具有相關赴港簽注的通行證上，才可來港居留。倘若 *本

*本人╱兒童受養人的進入許可標籤。如 *本人╱

人╱兒童受養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

兒童受養人持其他旅行證件，*本人╱兒童受養人將會被拒入境。

Should this application for an entry permit be successful, *I/the child dependant 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 residence. I understand that an entry permit granted

to *me/the child dependant is to be affixed onto an EEP with the relevant exit permission prior to *my/the child dependant’s arrival in Hong Kong for residence. In case

*my/the child dependant’s EEP bearing the relevant exit permission is an electronic EEP, *I/the child dependant should present it together with the entry permit granted

to *me/the child dependant for immigration arrival clearance. Should *I/ the child dependant enter Hong Kong on other travel document, *I/the child dependant will be

refused entry to Hong Kong.

(viii)

就本人所知所信，本申請表內甲部第 3 項關乎 * 本人／兒童受養人及乙部所塡報的所有資料均為正確、完備和真實。

All information given in item 3 of Part A concerning *me/the child dependant and all information given in Part B of this application form is correct, complete and

true to the best of my knowledge and belief.

*受養人簽署

日期

或

父／母／合法監護人姓名及簽

署

Date

*Signature of dependant or Name and signature of parent/legal guardian

注意 :

* 請將不適用者删去。 * Please delete where inappropriate.

Note:

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 residence. Please delete where inappropriate.

ID 990A (5/2014)