Application For Hksar Document Of Identity For Visa Purposes

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注意 (i)
請用黑色或藍色筆以正楷填寫本申請書。
香港特別行政區政府入境事務處
Note:
Please complete this form in BLOCK letters using black or blue pen.
Immigration Department, the Government of
(ii)
請在適當方格內填上「」號。
the Hong Kong Special Administrative Region
Please tick as appropriate.
(iii) 有「#」號的項目不適用於持有「前往港澳通行證」
香港特別行政區簽證身份書申請書
人士在首次登記身份證並同時辦理簽證身份書的申請。
(適用於十六歲或以上人士)
Items with「#」are not applicable to holders of Chinese Exit Permit who are
applying for the Document of Identity for Visa Purposes upon their first registration of
Application for HKSAR Document of Identity
Hong Kong identity card.
警告
如就此項申請作出虛假陳述或填報失實資料,即屬違法。
for Visa Purposes
Warning: It is an offence in law to furnish any false statement or information
(For persons 16 years of age or above)
relating to this application.
#
2. 申請類別
四十四頁 44 pages
首次申請 First application
換領 Replacement
1. 簽證身份書類別
或 or
Type of application
[見備註(iii)
#
因遺失/損毁/更改個人資料的申請
Type of Document of Identity
九十二頁 92 pages
Application due to loss/damage/amendment of personal particulars.
see Note (iii)]
3. 領證方式
於以下辦事處領取
Collection Means
At collection office below
(有關領證辦事處簡碼,請參閱申請書背頁)
[見備註(iii)
# 領證辦事處簡碼
(Please see back of application form for collection office code)
#see Note (iii)]
Collection office code
4. 個人資料 Personal Particulars
(以香港身份證所載者為準 As stated on Hong Kong identity card )
姓 (中文)
姓 (英文)
Surname in Chinese
Surname in English
名 (中文)
名 (英文)
Given names in Chinese
Given names in English
性別
出生日期
Female
Male
Sex
Date of birth
日 dd
月 mm
年 yyyy
香港身份證號碼 HK identity card no.
簽發日期
( )
Date of issue
此欄由辦理
日 dd
月 mm
年 yy
出生地點 Place of birth
機關處理
中國
其他國家
For Official
China
Other country
(請註明國家名稱)
Use Only
(請註明省、自治區、直轄市或特別行政區名稱)
(Please state country name only)
(Please indicate the name of the province, autonomous region,
municipality or special administrative region only)
現時持有旅行證件的種類和編號
簽發日期
Date of issue
Type and travel document no.
presently held
日 dd
月 mm
年 yy
Address
聯絡電話號碼 Contact telephone no
.
住址
(Please fill in within the border)
(請於邊界內填寫)
5. 附加資料
Additional Information
(如有)
(if any)
6. 未滿十八歲申請人的父、母或合法監護人同意書 Consent from Parent or Legal Guardian of Applicant under 18 Years of Age
本人,即下開簽署人,現謹此聲明:
(2) 本人對申請人的監護權並未受任何法院頒令所限制。
I, the undersigned, declare that:
My rights in respect of the applicant have not been limited in any way by the order of any court.
(1) 本人乃申請人的: My relationship with the applicant is:
(3) 本人同意此簽證身份書申請。
I consent to this application for the issue of a Document of Identity for Visa Purposes to him/her.
母親
父親
法庭頒令監護人
獲授權的監護人
mother
father
legal guardian (by court order)
legal guardian (by authorisation)
( )
中文姓名
本人的香港身份證號碼:
Name in Chinese
My HK identity card no.:
如非香港居民,請填寫
英文姓名
旅行證件類別及號碼:
Name in English
For non-Hong Kong resident,
please state travel document type and no.:
日期
簽署
Date
Signature
日 dd
月 mm
年 yyyy
7. 申請人聲明書 Declaration of Applicant
( * 請將不適用者删去 * Please delete where inappropriate)
本人,即下開簽署人,現謹此聲明: I, the undersigned, declare that:
(1) 本人從未在香港以外任何國家獲得居留身份。I have not obtained any residence in any country outside Hong Kong.
(2) *本人過往從未申請、持有或被拒發簽證身份書或由香港或任何其他地區簽發的任何其他種類的旅行證件。
*I have not previously applied for, held or been refused a Document of Identity for Visa Purposes, or any other form of travel document issued either in Hong Kong or any other territory.
(3) *除*隨附/現已報失/目前未能出示的*簽證身份書/入境許可證/旅行證件第________________________________號外,以往發給本人的簽證身份書或由香港或任何其他地區簽發的任何種類的旅行證件已
交還當局;而自獲發*隨附/已遺失/目前未能出示的*簽證身份書/入境許可證/旅行證件後,本人再無申請其他簽證身份書。
*Any Document of Identity for Visa Purposes, or travel document of any kind issued either in Hong Kong or any other territory previously granted to me has been surrendered other than *Document of Identity for
Visa Purposes/Entry Permit/travel document no.______________________________ which *is now attached/has been reported lost/is not available, and that I have not made an application for a Document of
Identity for Visa Purposes since the *attached/lost/unavailable *Document of Identity for Visa Purposes/Entry Permit/travel document was issued to me.
(4) 就本人所知及相信,此申請書所填報的資料均屬正確無誤。
The information given in this application is correct to the best of my knowledge and belief.
(5) 本人同意為處理此申請而須進行的任何查詢。
I consent to the making of any enquiries necessary for the processing of this application.
日期
申請人簽署
Date
Signature
of Applicant
日 dd
月 mm
年 yyyy
注意 Note: 請於邊界內簽署 Please sign within border
ID(E)437(1/2014)

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