Application Form For Public Rental Housing Page 3

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Choice of District Choose only one district. Please “” as appropriate:
Part 5
New Territories
Urban
(comprising Tuen
(comprising Hong Kong Island and
Mun, Yuen Long, Tin Shui Wai, Sheung
Kowloon)
Shui, Fanling and Tai Po)
Only applicants eligible for (1) SEPS, (2) EPS or
(3) those who opt to live with the elderly in one flat
Extended Urban
(comprising Tung
under HFPS can choose “Urban”. For other
Chung, Shatin, Ma On Shan, Tseung Kwan
applicants, their application forms will be
O, Tsuen Wan, Kwai Chung and Tsing Yi)
returned if they choose “Urban”.
Islands
(excluding Tung Chung)
Part 6
Other Supplementary Information
(Please fill in this part and inform the named relative if all persons in this
application are elderly)
Please provide the following details of one of your relatives who can be contacted in Hong Kong, if any:
Name of Relative:
Tel. No.:(Home)
(Mobile)
Address:
Part 7
Declaration of the Applicant and Family Members Aged 18 or Above
I/We agree and declare that:
I/We have read carefully and understood all the content of the “Application Guide” before completing the application form.
1.
I/We undertake to comply with the relevant requirements/arrangements contained therein, as well as PRH application/allocation
policies and arrangements set out by Housing Authority (HA)/Housing Department (HD) as required .
2.
As at the date of completing my/our application form, I/we have not owned, co-owned, entered into any agreement to purchase
or held more than 50% of shares in a company which owns (directly or through its subsidiary) any domestic property in Hong
Kong covered in the relevant term of the “Application Guide”;
3.
No person listed on this Application Form is duplicated in other PRH application(s) (i.e. family and elderly one-person
application/Quota and Points System non-elderly one-person application) ;
4.
If there is any change in the information declared concerning the application, I/we shall immediately notify HD in writing;
otherwise, HD may cancel my/our registered PRH application as it cannot be processed further;
5.
I/We understand that there is no restriction on the sex of the public housing applicants. Both male and female are eligible
applicants with equal rights and responsibilities;
6.
I/We agree that HA and HD may, in processing my/our application, collect my/our personal data from other relevant government
departments, public/private organisations (such as but not limited to financial institutions and banks), and/or any other third party
(such as but not limited to employers) possessing my/our personal data for verification and confirmation of my/our eligibility.
Whilst the collection of information is in progress, the personal data contained therein may be disclosed to the abovementioned
organisations and/or any other third party. In this connection, I/we authorise these organisations and/or any other third party
possessing my/our personal data to furnish HA and HD with my/our personal data for the vetting of my/our application;
7.
I/We agree that the information provided in this Application Form may be used by the HA and HD for statistical survey or
research, and I/we may be contacted for such a purpose;
8.
Upon allocation of PRH unit, my/our personal data and all correspondences relating to PRH application will be transferred to
the relevant Estate Office for the purpose of implementation of public housing policy and enforcement of tenancy conditions
for the allocated flat;and
9.
All the above particulars furnished in this Application Form are true and correct. I/We understand that by virtue of Section
26(1)(c) of the Housing Ordinance (Cap. 283), any person who knowingly makes any false statement to HA in respect of an
application for a public housing unit shall be guilty of an offence, and shall be liable on conviction to a fine at Level 5 as
specified in Schedule 8 to the Criminal Procedure Ordinance (Cap. 221) and to imprisonment for 6 months (as at the date of the
revision of this Application Form, the maximum fine at Level 5 is HK$50,000). If I/we make false statement or furnish false
information when applying for PRH, irrespective of whether I/we shall be prosecuted for or convicted of the offence, or
whether the false statement/false information has any impact on the eligibility of the PRH application, HA may cancel the
registered PRH application. HA may also terminate the tenancy agreement acquired through making false statement /
furnishing false information by virtue of its powers conferred under the Housing Ordinance.
Attention:
(i)
The Applicant and all family members aged 18 or above who are listed in Part 1 are required to sign below.
(ii) The Applicant shall be held liable for the data of family member(s) aged below 18 furnished herein.
Name
H.K.I.C. No.
Signature
Applicant
(
)
(
)
Family Member
(
)
Family Member
(
)
Family Member
(
)
Family Member
Date
(Day | Month | Year)
HD300E (Rev 2/2015)
(Please go on next page)
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