Application Form For Public Rental Housing
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1
2
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4For Official Use by HD Only
APPLICATION FORM
Housing Department
Date Registered
Applications Sub-section,
FOR PUBLIC RENTAL HOUSING
P.O. Box 89192, Kowloon City Post Office
Hong Kong
Applicants should:
Application Number
read carefully the eligibility criteria in the “Application Guide for Public Rental Housing
1.
(PRH)”(“Application Guide”) and the “Sample of Completed Application Form” before
completing this Form;
2.
read the definition and computation method of average waiting time (AWT) at Note 4 on Page 4.
Split from
3.
fill in all the information required in this Form and submit the supporting documents and
declaration form(s) concerned (as required under Part 8 “Checklist of Supporting Documents
for PRH Applications” of this Form), otherwise this Form will be returned and the registration
process may as a result be delayed; and
4.
use black or blue ball pen to fill in this Form. Sign against amendments, if any, and avoid using
correction materials such as correction fluid or tapes for obliteration, otherwise this Form will
be returned.
Part 1 Personal Data
(For applications involving over 5 persons, please use an additional form and submit both forms together.)
Applicant
Family Member Family Member Family Member Family Member
Name in Chinese (if any)
Given Name
English
Surname
□M
□F
□M
□F
□M
□F
□M
□F
□M
□F
Sex
(Please “”)
Date of Birth
Day Month Year
/
/
Relationship with Applicant
Applicant
□Unmarried □Married
□Unmarried □Married
□Unmarried □Married
□Unmarried □Married
□Unmarried □Married
Marital Status
□Divorced □Widowed
□Divorced □Widowed
□Divorced □Widowed
□Divorced □Widowed
□Divorced □Widowed
(Please “”)
□
□
□
□
□
Under divorce proceedings
Under divorce proceedings
Under divorce proceedings
Under divorce proceedings
Under divorce proceedings
Hong Kong Identity
Card
( )
( )
( )
( )
( )
(H.K.I.C.) No.
Hong Kong Birth Certificate
( )
( )
( )
( )
Not Applicable
No.
(if H.K.I.C. not yet issued)
Date of Entry
Month Year
(if not born in Hong Kong)
If having disability as at
□1
□2
□3
□1
□2
□3
□1
□2
□3
□1
□2
□3
□1
□2
□3
Note 1, please
“”
□4
□5
□6
□4
□5
□6
□4
□5
□6
□4
□5
□6
□4
□5
□6
□ Subvented
□ Subvented
□ Subvented
□ Subvented
□ Subvented
If residing at Elderly Care
Centre, please “”
□ Private
□ Private
□ Private
□ Private
□ Private
Note 2
If receiving CSSA
,
□
□
□
□
□
please “”
If pregnant over 16 weeks,
□
□
□
□
□
please “”
Hong Kong Contact Tel. No. of Applicant:
(Home)
(Mobile)
(Office)
Note 1:
Disability code : 1. Non-temporary indoor dependence on wheelchair for mobility; 2. Tetraplegia; 3. Hyperactivity disorder; 4. Need for peritoneal dialysis at home;
5. Visual impairment/blindness; 6. Hearing impairment/deafness (For Items 1 to 4, relevant medical document is required).
CSSA refers to Comprehensive Social Security Assistance; disability allowance and old age allowance are excluded (Copy of latest CSSA documents and the CSSA recipients’
Note 2:
certificate for medical waivers are required).
Part 2
Correspondence and Residential Addresses in Hong Kong (HK)
(To avoid misdelivery, please write in block letters.
Please notify Housing Department if there are any changes in future.)
Correspondence Address in HK (must be completed, and if the
Residential Address in HK
same to the residential address, must provide documentary proof)
(must be completed if different from the Correspondence Address, and
Name of Applicant
must provide documentary proof)
Flat/Unit/Room No.
Floor
Block No.
Building Name
Flat/Unit/Room No.
Floor
Block No.
Building Name
Estate Name
Estate Name
Street No.
Street Name
Street No.
Street Name
District
HK
KLN
NT
Islands
Post Office/P.O. Box No.
HK
KLN
NT
Islands
District
(if applicable)
Relationship & Marital Status
P
□Y
□N
□Y □N
□Y
□N
□Y
□N
□Y □N
R/R Fulfilled
Disability Code
HD300E (Rev 2/2015)
(Please go on next page)
Page 1 of 4
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