Application for a Statement of Travel Records

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洲妇萧
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1 Ú Í Immigration Department The Government of the Hong Kong Special Administrative Region âÿ ð Application for a Statement of Travel Records å Note œð õ ë ð ë Please read Notes for guidance overleaf before completing this form. 2. á Ÿ For Official Use Only Appn Ref: A. Letter C/L Required CiPer / CbPo Fee Others: Warning : Ÿ ³ ²Ý šµ æ It is an offence in law to furnish any false statement or information relating to this application. I - ÞŸ ë Part I - The Travel Records being applied Í ë Particulars of the data subject: 姓名 ( 中文 ) ( 如適用 ) Name in Chinese (if applicable) ) Surname in English ) Given names in English «Alias (if any) Ý Ç ˆ Sex Male ž Female of birth dd mm yyyy Nationality Travel Document no. Þ ë Required travel records period: õ ( ž) Maiden surname (if applicable) Ê ( «) HK Identity Card no.(if any) ( ) Ÿ From dd mm yyyy to dd mm yyyy ž The data will be used for: Ÿ â Part II - Particulars and Declaration of the Applicant œ µ Ê ³ Ÿ I, the undersigned, make this application in my capacity as: d ë Í The data subject of the above-mentioned travel records. d ð Í ³ ë œ * ª ë Í «³ ë Í / Ÿæ Ö Í Í On behalf of the above-mentioned data subject. I * have parental responsibility for the data subject who is a minor / am authorized in writing by the data subject / am appointed by a Court to manage the affairs of the data subject. Ÿ (ð ë Signature of applicant (Please see Note 5) Ÿ Full name (Surname first) ¹ Correspondence Address Š žíµ Ì ð ë š Ÿ For Official Use Only Telephone No. Fee Paid Register No. Receipt No. Receiving Application checked in order. Case Application approved/refused. Authorising STR posted to applicant by registered mail. Serial No. By: ID 697 (2/2011)

2 填表須知一領取本表格毋須繳費二本表格可用中文或英文填寫, 請用黑色或藍色筆以正楷填寫本表格三本處未能提供十年前的出入境紀錄四此項申請所需的文件 (i) 資料當事人的身份證明文件 ( 例如旅行證件 ) 載有其個人資料及簽名式樣專頁的副本 ; (ii) 資料當事人的香港身份證副本 ( 訪港旅客除外 ); 及 (iii) 如申請人並非資料當事人 ( 例如 : 是未成年資料當事人的父母親或已獲資料當事人書面授權的人士 ), 除需提供自己及資料當事人有關上列 (i) 和 (ii) 的文件外, 還須提交文件證明申請人替資料當事人取得上述出入境紀錄的資格, 例如 : 授權書資料當事人的出生證明書副本法庭命令副本等五本表格須由申請人簽署簽名式樣須與所遞交的身份證明文件 ( 例如旅行證件 ) 副本上的簽名相同六申請出入境紀錄證明所需的費用, 可參閱收費表 (ID 912) 七遞交申請書 (i) 申請書可用郵遞方式寄回香港灣仔告士打道七號入境事務大樓入境事務處紀錄中心 ; (ii) 申請人遞交申請書時, 必須連同上述所需的文件及須繳付的費用一併遞交本處申請人須以劃線支票銀行匯票或本票繳費, 並註明支付香港特別行政區政府請勿郵寄現金期票通常不獲接受 ; 及 (iii) 請連同申請書交回已塡妥姓名和回郵地址的郵寄標籤 (ID 839) 及認收通知卡 (ID 697A) 八出入境紀錄證明的簽發本處在收妥所需文件後, 一般需時大約十個工作天處理有關申請 ( 工作天是指星期一至星期五, 公眾假期除外 ) 申請結果將會用已由申請人塡妥姓名和回郵地址的郵寄標籤 (ID 839) 以掛號郵件方式寄回申請人九查詢申請人可在本處網頁瀏覽一些常見問題的答案如有任何查詢或需要更多資料, 請致電或以圖文傳真方式 : 或透過網址 : 向入境事務處提出 Notes for guidance 1. This form is issued free of charge. 2. This form may be completed in Chinese or English. Please complete this form in BLOCK letters using black or blue pen. 3. Travel records earlier than preceding ten years are not available. 4. Documents required for the application (i) One photocopy of the particulars and signature pages of the data subject s proof of identity (e.g. travel document); 5 (ii) (iii) One photocopy of the data subject s Hong Kong Identity Card (except for visitor to Hong Kong); and If applicant is not the data subject (e.g. being the parent of the data subject who is a minor or being authorized in writing by the data subject), then on top of providing both the data subject s and the applicant s supporting documents stated at (i) and (ii) above, submission of documents which can sufficiently prove the applicant s eligibility to obtain the travel records will also be required (e.g. authorization letter, copy of data subject s birth certificate, copy of court order, etc.). The form must be signed by the applicant. The signature should be identical to that on the copy of proof of identity (e.g. travel document) submitted. 6. The fee for a Statement of Travel Records is shown on the fee leaflet (ID 912). 7. Submission of application (i) Application can be sent by post to the Records Centre, Immigration Department, Immigration Tower, 7 Gloucester Road, Wan Chai, Hong Kong; (ii) (iii) The application must be submitted together with the above-mentioned supporting documents and payment required by crossed cheque, bank draft or cashier order payable to The Government of the Hong Kong Special Administrative Region. Cash should not be sent through post. Post-dated cheque will not normally be accepted; and Please return the application with a completed Mailing Label (ID 839) and a self-addressed Acknowledgement Card (ID 697A). 8. Issue of Statement of Travel Records It normally takes around 10 working days to process an application for a Statement of Travel Records upon receipt of all necessary documents (working days mean Monday to Friday excluding General Holidays). The result of the application will be sent to the correspondence address completed by the applicant on the Mailing Label (ID 839) by registered mail. 9. Enquiries You can browse for the answers to frequently asked questions in the Immigration Department s website at If you have any enquiries or need more information, please contact the Immigration Department on telephone number: or by fax: or through website:

3 收集個人資料的目的收集資料的目的申請表格內所提供的個人資料, 入境事務處會用作下列一項或多項的用途 :- ( 甲 ) 辦理你的申請 ; ( 乙 ) 實施 / 執行入境條例 ( 第 115 章 ) 及入境事務隊條例 ( 第 331 章 ) 的有關條文規定, 以及履行入境管制職務, 藉此協助其他政府決策局和部門執行其他法例 ; ( 丙 ) 在有關人士向入境事務處提出申請並提名你為保證人或諮詢人時, 將你的資料供作核對用途 ; ( 丁 ) 供作統計及研究用途, 但所得的統計數字或研究成果不會以識辨各有關的資料當事人或其中任何人的身份的形式提供 ; 以及 ( 戊 ) 供作法例規定授權或准許的其他合法用途在申請表格內的個人資料是自願提供的如果你未能提供足夠資料, 本處或許不能辦理你的申請資料轉交的類別為了上述目的, 你所提供的個人資料或許會轉交其他政府決策局和部門, 以及其他機構查閱個人資料根據個人資料 ( 私隱 ) 條例 ( 第 486 章第 18 及 22 條以及附表 1 第 6 項原則, 你有權要求查閱及改正自己的個人資料你的查閱權利包括在繳交有關費用後, 索取你在申請表格內所提供的個人資料的副本查詢有關查詢表格內的個人資料, 包括查閱或改正, 可向下列人員提出 :- 香港灣仔告士打道七號入境事務大樓總入境事務主任 ( 紀錄中心 ) 電話 : Statement of Purpose Purpose of Collection The personal data provided in the application form will be used by the Immigration Department for one or more of the following purposes:- (a) (b) (c) (d) (e) to process your application; to administer/enforce relevant provisions of the Immigration Ordinance (Chapter 115) and Immigration Service Ordinance (Chapter 331), and to assist in the enforcement of any other Ordinances and Regulations by other government bureaux and departments through carrying out immigration control duties; to process other person s application for immigration facilities in which you are named as a sponsor or referee; for statistics and research purposes on the condition that the resulting statistics or results of the research will not be made available in a form which will identify the data subjects or any of them; and any other legitimate purposes as may be required, authorized or permitted by law. The provision of personal data in the process of your application is voluntary. If you do not provide sufficient information, we may not be able to process your application. Classes of Transferees The personal data you provide may be disclosed to government bureaux, departments and other organizations for the purposes mentioned above. Access to Personal Data You have a right to request access to and correction of your personal data as provided for in sections 18 and 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance (Chapter 486). Your right of access includes the right to obtain a copy of your personal data provided in the application form subject to payment of a fee. Enquiries Enquiries concerning the personal data collected by means of the application form, including making of access and corrections, should be addressed to:- Chief Immigration Officer (Records Centre) Immigration Tower, 7 Gloucester Road, Wan Chai, Hong Kong. Tel. No.:

4 Immigration Department The Government of the Hong Kong Special Administrative Region Acknowledgement Card Application reference ( Please quote this application reference in your future correspondence) Applicant s name This is to acknowledge receipt of the above application for a Statement of Travel Records from the abovenamed. It normally takes 10 working days to process an application for a Statement of Travel Records upon receipt of all necessary documents. The result of the application will be sent to your correspondence address by registered mail. Please do not enquire about the progress of the application unless it is absolutely necessary, as this may delay the processing of your application. ( : ) (NB : Please enter the applicant s name in the space provided above and the applicant s name and correspondence address on the reverse side. This card should be submitted together with the application for a Statement of Travel Records and a completed Mailing Label.) ON GOVERNMENT SERVICE NAME ADDRESS ID 697A

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ch_code_infoaccess 地產代理監管局公開資料守則 2014 年 5 月目錄引言第 1 部段數適用範圍 1.1-1.2 監管局部門 1.1 紀律研訊 1.2 提供資料 1.3-1.6 按慣例公布或供查閱的資料 1.3-1.4 應要求提供的資料 1.5 法定義務及限制 1.6 程序 1.7-1.19 公開資