Form Id(E) 936 - Visa/entry Permit Application Form Page 16
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18This form is applicable to
all entry applications
File reference:
Declaration of applicant
(To be completed and declared by applicant)
To : Director of Immigration
Application for Hong Kong Visa/Entry Permit
I, _______________________________________________, in applying for a
visa/entry permit for entry into the Hong Kong Special Administrative Region
(HKSAR) / change of status in HKSAR, declare the following :
1.
I have not changed my name before.
I have used the following name(s) before:
________________________________________________________
________________________________________________________
2.
I have not been refused entry to, deported from, removed from or
required to leave Hong Kong.
I have been refused entry to, deported from, removed from or
required to leave Hong Kong. The date(s) and details are:
________________________________________________________
3.
I have not been refused a visa/entry permit for entry to Hong Kong.
I have been refused a visa/entry permit for entry to Hong Kong
before. The date(s) and details are:
________________________________________________________
I hereby declare that all the information given above is correct and complete.
Date
Signature of Applicant
Please tick ( ) in appropriate box
L
ID(E) 936
(1 page)
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