Appendix I

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1 請將申請書交回 : 香港灣仔皇后大道東 258 號 1 樓 119 室食物進 / 出口組食物進口商 / 分銷商登記及進口簽證辦事處電話號碼 : 傳真號碼 : 電郵地址 :[email protected] Application may be submitted by e-form and must be digitally signed. 申請可以電子表格遞交, 但須加上數碼簽署 Application form to be sent to: Food Importer/Distributor Registration and Import Licensing Office Food Import & Export Section Room 119, 1/F, 258 Queen s Road East, Wan Chai, Hong Kong Tel. No.: Fax No.: address : [email protected]. hk 根據立法前自願登記計劃登記成為蛋類製品經處理果菜類製品乳類製品豆類食品堅果及種子類食品進口商 / 分銷商申請書 Application for Registration as Importer/Distributor of Egg Products, Processed Vegetable and Fruit Products, Dairy Products, Legumes, Nuts and Seeds under the Pre-Statutory Voluntary Registration Scheme ( 填寫此表格前, 請參閱第 6 及第 7 頁的填表須知 ) (Please read the Guide to Completing the Application Form at P. 6 & P.7 before completing this form.) 本公司現申請登記成為 - 蛋類製品進口商分銷商 We apply for registration as egg products importer distributor ( 請在適當方格內劃上號 ) (Please insert in the appropriate box(es).) - 經處理果菜類製品進口商分銷商 processed vegetable and fruit products importer distributor - 乳類製品進口商分銷商 dairy products importer distributor - 豆類食品進口商分銷商 legumes importer distributor - 堅果及種子類食品進口商分銷商 nuts and seeds importer distributor 甲部 Part A 食品種類 Food Category 請提供貴公司進口 / 分銷的食物種類 ( 不需提供食品牌子名稱 ) Please state the food type imported/ distributed by your company. (Brand name is not required). 有關食品種類的例子, 請參閱第 7 頁的填表須知 Examples in each food category, please refer to the Guide to Completing the Application Form at P. 蛋類製品 egg products

申請可以電子表格遞交, 但須加上數碼簽署 Application form to be sent to: Food Importer/Distributor Registration and Import Licensing Office Food Import & Export Section Room 119, 1/F, 258 Queen s Road

2 如空格不敷應用, 請用第 8 及第 9 頁的附錄表格填寫 If there is not enough space, please use the form in Appendix at P. 8 & P. 經處理果菜類製品 processed vegetable and fruit products 乳類製品 dairy products 豆類食品 legumes 堅果及種子類食品 nuts and seeds 2

經處理果菜類製品 processed vegetable and fruit products 乳類製

3 中文名稱 # Name in Chinese # 英文名稱 # Name in English # 擁有人 / 董事姓名 Name(s) of Owner(s)/Director(s) 商業登記號碼乙部 Part B Business Registration No. ( 如郵遞或親身提交申請, 請提供公司的商業登記證副本, 如以電子表格遞交, 須加上數碼簽署 ) 公司 / 登記業務 # (For application by post or by hand, please provide a copy of business registration certificate of your Company/Registered Business # company. Application submitted by e-form must be digitally signed.) 辦事處地址 # Office Address # 電話號碼 # Tel. No. # 傳真號碼 Fax No. 電郵地址 Address 丙部 Part C 聯絡人 Contact Person ( 請提供一位聯絡人的詳細資料作緊急聯絡用途 ) (Please provide details of a contact person for emergency contact purpose.) 中文姓名 Name in Chinese 英文姓名 Name in English 緊急聯絡電話號碼 Emergency Contact Tel. No. 傳真號碼 Fax No. 電郵地址 Address 辦事處 Office 流動電話 Mobile Phone 3

your Company/Registered Business # company. Application submitted by e-form must be digitally signed.) 辦事處地址 # Office Address # 電話號碼 # Tel. No. # 傳真號碼 Fax No.

4 聲明 DECLARATION 本人 ( 請以正楷填寫姓名 ) ( 香港身分證號碼 ) I, (English Name in Block Letters) (HKID Card No. ) am 為上述公司 / 登記業務的東主, Proprietor 合伙人, Partner 董事, Director 獲正式授權的負責人, Responsible person duly authorised by the Company/Business 其他, 請說明 : Others, please specify ( 請在適當方格內劃上 " 號 ) (Please insert in the appropriate box.) 現謹此作以下聲明 : of the above company/registered business and hereby declare that: (a) (b) 本人獲正式授權代表上述公司 / 登記業務提出此項申請並作出聲明, 以登記成為蛋類製品 / 經處理果菜類製品 / 乳類製品 / 豆類食品 / 堅果及種子類食品 * 的進口商 / 分銷商 *, 並完全明白夾附的用途聲明 I am duly authorised to make this application and declaration on behalf of the above-named company/registered business for registration as importer/distributor* of egg products/processed vegetable and fruit products/dairy products/legumes/nuts and seeds* and fully understand the Statement of Purpose as attached. 本人承諾如本申請書內及食物安全中心日後要求提供的其他文件內的資料有任何更改, 會通知食物安全中心 I undertake to inform the Centre for Food Safety of any changes to the particulars supplied in this application and any other document(s) as requested by the Centre for Food Safety in future. (c) 本人同意 / 不同意 * 將本申請書內的公司 / 登記業務 ( 劃有 # 號的名稱地址和電話號碼 ) 上載至食物安全中心網頁, 以供公眾參考 I agree/do not agree* to the uploading of the information of the company/registered business (the name, address and telephone number marked in # ) in this application to the website of the Centre for Food Safety for information of the public. 簽署 Signature : 職銜 Position held: 日期 Date: 公司印章 Company chop: * 請刪去不適用者 Please delete where appropriate. 4

內劃上 " 號 ) (Please insert in the appropriate box.

5 用途聲明 Statement of Purpose ( 根據個人資料 ( 私隱 ) 條例作出 ) ( 向資料當事人展示或提供 ) (under the Personal Data (Privacy) Ordinance) (to be displayed or provided to data subjects) 收集資料的目的 Purpose of Collection 你所提供的個人資料, 會由食物環境衞生署 ( 本署 ") 食物安全中心用作食物安全管制用途個人資料的提供, 純屬自願如果你不提供充分的資料, 我們未必能夠處理你的申請, 或在有需要時提供協助 The personal data are provided by individuals to the Centre for Food Safety, Food and Environmental Hygiene Department ( this Department ) for the purposes of food safety control. The provision of personal data is voluntary. If you do not provide sufficient information, we may not be able to process your application or provide assistance to you where appropriate. 接受轉介人的類別 Classes of Transferees 你所提供的個人資料, 主要由本署內部使用, 但亦可能在有需要時因以上第 1 段所列目的向其他政府決策局和部門或有關方面 ( 包括一般市民 ) 披露此外, 資料只可於你同意作出該種披露或作出該種披露是個人資料 ( 私隱 ) 條例所允許的情況下, 才向有關方面披露 The personal data you provide are mainly for use within this Department but they may also be disclosed to other Government bureaux and departments or other parties (including the general public) for the purposes mentioned in paragraph 1 above. Apart from this, the personal data may only be disclosed to those parties where you have given prior consent to such disclosure or where such disclosure is allowed under the Personal Data (Privacy) Ordinance. 查閱個人資料 Access to Personal Data 根據個人資料 ( 私隱 ) 條例第 18 條及 22 條以及附表 1 第 6 原則所述, 你有權查閱及修正個人資料, 包括有權取得個人資料應查閱要求而提供資料時, 可能要徵收費用 You have a right of access and correction with respect to personal data as provided for in sections 18 and 22 and Principle 6 of Schedule 1 to the Personal Data (Privacy) Ordinance. Your right of access includes the right to obtain a copy of your personal data. A fee may be imposed for complying with a data access request. 查詢 Enquiries 有關所提供個人資料的查詢 ( 包括查閱及修正資料 ), 請送交 : Enquiries concerning the personal data provided, including making access and corrections, should be addressed to: 香港灣仔皇后大道東 258 號 1 樓 119 室食物環境衞生署食物安全中心食物進 / 出口組食物進口商 / 分銷商登記及進口簽證辦事處高級衞生督察 ( 進 / 出口 ) 入口登記電話號碼 : ( 辦公時間 : 星期一至星期五上午八時四十五分至下午六時 ) Senior Health Inspector (Import/Export) Import Registration Food Importer/Distributor Registration and Import Licensing Office Food Import & Export Section Centre for Food Safety Food and Environmental Hygiene Department Room 119, 1/F, 258 Queen s Road East, Wan Chai, Hong Kong Tel. No. : (Office hours: Monday to Friday 8:45 a.m. to 6:00 p.m.) 5

personal data are provided by individuals to the Centre for Food Safety, Food and Environmental Hygiene Department ( this Department ) for the purposes of food safety control.

6 填表須知 Guide to Completing the Application Form 任何人士或公司進囗及 / 或分銷蛋類製品經處理果菜類製品乳類製品豆類食品堅果及種子類食品, 均應根據立法前自願登記計劃 ( 計劃 ) 向食物安全中心 ( 中心 ) 登記 Any person or company imports and/or distributes egg products, processed vegetable and fruit products, dairy products, legumes, nuts and seeds should register with the Centre for Food Safety (CFS) of their business in accordance with the Pre-Statutory Voluntary Registration Scheme (the Scheme). 分銷業務包括將進口 / 或經本地處理後的蛋類製品經處理果菜類製品乳類製品豆類食品堅果及種子類食品分銷至其他分銷商 / 零售商 Distribution business includes distributing imported and/or locally processed egg products, processed vegetable and fruit products, dairy products, legumes, nuts and seeds to other distributor(s)/retailer(s). 請於遞交申請時, 附上公司的商業登記證副本 Please provide a copy of business registration certificate of your company together with your application. 如業務只屬零售性質, 則無須根據立法前自願登記計劃向中心登記 Company engaging in retail business only is not required to register with the CFS of their business under the Pre-Statutory Voluntary Registration Scheme. 6

their business in accordance with the Pre-Statutory Voluntary Registration Scheme (the Scheme).

7 有關食品種類, 請參考下列的常見例子 - Examples in each food category, please refer to the table below for reference - 食品種類 Food Category 蛋類製品 egg products 經處理果菜類製品 processed vegetable and fruit products 乳類製品 dairy products 豆類食品 legumes 堅果及種子類食品 nuts and seeds 例子 Examples 鹵水雞蛋 ( 已除殼 ) 茶葉雞蛋 ( 已除殼 ) 蛋玉子豆腐蛋奶酒雞蛋白鴨蛋黃 Shelled marinated chicken egg, Shelled tea leaf chicken egg, Egg bean curd, Eggnog, Chicken egg white, Duck egg yolk 柚皮八仙果欖角檳榔山楂餅九制陳皮醃製雜果菜脯榨菜芋絲清心丸五柳欖菜金針菜韓國泡菜醬瓜冬菜鹹酸菜酸蕎頭日式醃蘿蔔乾蔥頭雪菜梅菜貢菜齋 ( 蒟蒻製 ) 髮菜紫菜薯片雪耳木耳大菜姬松茸竹笙榆耳羊棲菜海帶猴頭菇蠔菇零食紫菜茶樹菇黃耳冬菇 Pummelo peel, Preserved pummelo, Preserved Chinese white olive, Arecanut, Haw roll, Preserved orange, Preserved mixed fruits, Dried radish, Preserved Sichuan mustard, Konjac noodle, Root starch jelly, Ng lau, Cooked green olives and fermented vegetables, Daylily flower, Kimchi, Pickled cucumber, Preserved cabbage, Preserved leaf mustard, Preserved rakkyo, Japanese preserved radish, Dried shallot bulb, Preserved mustard greens, Mui choy, Tribute vegetable, Vegetarian food (Konjac), Black-moss, Laver (seaweed), Potato chips, White fungus, Ear-fungus, Agar agar, Agaricus blazei murill, Bamboo fungus, Gloeosterem incarnatum S. Ito et Imai, Hijiki Seaweed, Kelp (seaweed), Monkey head mushroom, Oyster mushroom, Seaweed (prepackaged), Tea tree mushroom, Tremella frondosa Fr., Winter mushroom 奶昔煉奶淡奶芝士大良牛乳乳酪酪乳植脂奶發酵飲品 Milk shake, Condensed milk, Evaporated milk, Cheese, Chinese Cheese, Yoghurt, Buttermilk, Filled Milk, Fermented beverages 紅豆黑豆蠶豆扁豆腰豆綠豆黃豆日式豆腐角豆腐卜南乳豆豉豆腐乾枝竹茄汁焗豆腐乳齋 ( 黃豆製 ) 粉絲粉皮豆腐腐皮腐竹 Adzuki bean, Black soybean, Broad bean, Indian bean, Kidney bean, Mung bean, Soybean, Japanese tofu skin, Fried tofu, Fermented red bean curd, Fermented black soybean, Dried soybean curd, Soy bamboo, Ketchup baked beans, Fermented bean curd, Vegetarian food (soybean product), Mung bean noodles, Mung bean starch sheet, Soybean curd, Soybean sheet, Soybean stick 夏威夷果仁開心果榛子栗子腰果杏仁椰子合桃松子仁花生瓜子芝麻亞麻籽椰漿椰絲菱角南北杏白果罌粟籽可樂果蓮子椰果葵花籽 Macadamia, Pistachio nut, Hazelnut, Chestnut, Cashew, Almond, Coconut, Walnut, Pine nuts, Peanut, Watermelon seed, Sesame seed, Flax seed, Coconut milk, Desiccated coconut, Water caltrop, Apricot kernel, Ginkgo, Poppy seed, Kola nut, Lotus seed, Nata de coco, Sunflower seed 7

Shelled tea leaf chicken egg, Egg bean curd, Eggnog, Chicken egg white, Duck egg yolk 柚皮八仙果欖角檳榔山楂餅九制陳皮醃製雜果菜脯榨菜芋絲清心丸五柳欖菜金針菜韓國泡菜醬瓜冬菜鹹酸菜酸蕎頭日式醃蘿蔔乾蔥

8 蛋類製品 egg products 經處理果菜類製品 processed vegetable and fruit products 乳類製品 dairy products 附錄 Appendix 8

9 豆類食品 legumes 堅果及種子類食品 nuts and seeds 9

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