CFS-进口许可证申请表

FEHB284(04/2022)TheGovernmentoftheHongKongSpecialAdministratiApplicationForLicencetoImportFrozen/ChilledMea請將申請表交回：香港灣仔皇后大道東258號1樓119室食物進口商／分銷商登記及進口簽證辦事處電話號碼：21563041／21563042Applicationformtobesentto:FoodImporter/DistributorRegistrationandImportLicensingOfficeRoom119,1/F,258Queen’sRoadEast,WanChaiHongKongTel.No.:21563041/21563042請選擇以下其中一項，如多於一項請另交申請。Pleaseselectoneofthefollowing.Applyseparatelyformorethanon□冷藏肉類FrozenMeat□冷藏家禽FrozenPoultry□冰鮮肉類ChilledMeat□冰鮮家禽ChilledPoultry食物商登記號碼／獲豁免號碼TraderRegistrationNo./ExemptionNo.商業登記號碼BusinessRegistratio食物來源地PlaceofFoodOrigin國家／地方Country/Place州／省縣／郡Prefecture/County市CRelevantImportPermissionNo.(ifapplicable)DateofIssuePlaceofExportEstimatedDateofArrivalTransportationtoHK□陸路(車輛)Land(Vehicle)□陸路(鐵路)Land(Railway)□海運Sea□空運Air標記／貨櫃編號□食物在抵港前不會經過轉運。ThefoodwillnotbetranshippedbeforearrivinginHongKong.□食物會經（國家／地方）轉運至香港。Thefoodwillbetranshippedvia(country/place)toHongKong.進口食物詳情#DetailsofImportedFood#No.衞生證明書編號或歐盟出口申報編號HealthCertificateNo.EUExportDeclaration食物說明（請依照衞生證明書／出口申報列FoodDescription(pleasefollowtheexactiteandorderinhealthcertificate/exportdeclar包裝種類及件數（箱／板）（公斤／公噸／磅）NetWeight（以港元計）#如空格不敷應用，請用第4頁的附加頁填寫。Ifthereisnotenoughspace,pleaseusethesupplementarysheetatpage4.^到岸價指進口商截至載貨船隻、車輛或飛機抵達香港時所付出的貨物成本（連保險、運費及任何其他費用在內）。C.I.F.Valueisthecostofthegoodsincurredtotheimporteruptothearrivalofthevessel,vehicleoraircraftcarryingthegoodstoHongKong,togetherwiththeinsurance,theshippingcostandanyothercharges.HKDmeansHongKongDollar.□請在適當的方格內填上「」號。Pleaseticktheappropriatebox(es).FEHB284(04/2022)屠宰工廠#Slaughteringpla項目編號工廠編號PlantNo.Name加工廠#Processingplan項目編號工廠編號PlantNo.Name#如空格不敷應用，請用第4頁的附加頁填寫。Ifthereisnotenoughspace,pleaseusethesupplementarysheetatpage4.□食物用作本銷。Thefoodisforlocalconsumption.□食物用作轉口往(□內地/□澳門/□其他地方:）。Thefoodisforre-exporttoTheMainland相關轉口書面准許編號及簽發日期：RelevantRe-exportPermissionNo.andDateofIssue進口商聲明書Importer’sDeclarationIherebydeclarethatIamtheimporterofthefoodinrespectofwhichthisdeclarationismadeandttrueandthatthefoodimportedshallbeasdescribed.Ifully申請人姓名：NameofApplicant（請以正楷填寫）簽署：公司印章：□請在適當的方格內填上「」號。Pleaseticktheappropriatebox(es).FEHB284(04/2022)收集個人資料聲明PersonalInformationCollectionStatement1.收集資料的目的Purposeo你在本申請表格所提供的個人資料,會由食物環境衞生署作規控食物入口及食物安全用途。提供個人資料與否純屬自願。但如果提供的資料不足，我們可能無法處理你的申請。Yourpersonaldataprovidedbymeansofthisapplicationfoodimportationandfoodsafety.Theprovisionofpersonaldataisvoluntary.However,ifyoudmaynotbeabletoprocessyourapplication.2.資料轉交的對象ClassesofTransferees船運、航空或運輸公司。此外，你的個人資料只會披露給你曾同意向其披露的相關各方，或用作《個人資料（私隱的資料披露。ThepersonaldatayouprovidearemainlyforusewithinthisDepartmentbutiabove.Apartfromthis,thedatamayonlybedisclosedtopartieswhereyouhavegiisallowedunderthePersonalData(Privacy)Ordinanc3.查閱及修正個人資料AccessandCorrectiontoPersonalData根據《個人資料（私隱）條例》第18、22條及附表1第6原則所述，你有權查閱及修正個人資料,包括有權取得你在本申請表格提供的個人資料副本。查閱資料或須收費。accessandcorrectionwithrespecttofthePersonalData(Privacy)Ordinance.Yourrightofaccessincludestherighttoobtainacopyofyoapplicationform.Afeemaybeimposedforc有關所提供的個人資料的查詢（包括查閱及修正資料),請送交：香港金鐘道66號金鐘道政府合署43Enquiriesconcerningthepersonaldataprovided,includingmakingaccessandcorrections,shouldbeaSeniorExecutiveOfficerCentreforFoodSafety,FoodandEnvironmenta43rdFloor,QueenswayGovernmentOffices,66Queensway,HoFEHB284(04/2022)進口食物詳情DetailsofImportedFood項目編號衞生證明書編號或歐盟出口申報編號HealthCertificateNo.EUExportDeclaration食物說明（請依照衞生證明書／出口申報列FoodDescription(pleasefollowtheexactiteandorderinhealthcertificate/exportdeclar包裝種類及件數（箱／板）（公斤／公噸／磅）NetWeight（以港元計）屠宰工廠Slaughteringp項目編號工廠編號PlantNo.Name加工廠Processingpla項目編號工廠編號PlantNo.Name^到岸價指進口商截至載貨船隻、車輛或飛機抵達香港時