Environmental Protection Department

環 境 保 護 署
Waste Disposal Ordinance (Chapter 354)
香港法例第 354 章廢物處置條例
Waste Disposal (Chemical Waste)(General)Regulation
廢物處置(
廢物處置 (化學廢物化學廢物)((
化學廢物 般)規例
Application for Registration as a Waste Producer
廢物產生者登記申請表

A. Waste Name of Applicant (English) (Chinese)

Producer (中請人或機構名稱) : (英 文) _____________________ ( 中 文)
廢物產生者 Business Reg. Cert. No. (if any)
(商 業 登 記 證 編 號 ) : (如 有 者 )
1.0. Card No. (For application made by an individual only)
(身 分 證 編 號 ) : ( 倘 向 個 人 中 請 )
Address for Correspondence
( 通 訊 地 址 ):

Tel. No. Fax No.

(( 電 話) :________________________(圖文傳真) :

B. D
Location or Name of Establishment
Premises where (( 機 構 名 稱 ) :
the waste is Business Reg. Cert. No. (if any)
produced ( 商 業 登 記 證 編 號 ) : (如有者)
產生廢物的 Nature of Business
地點或樓宇 D( 業 務 性 臂 ):
Major chemical waste types
(( 主 要 化 學 廢 物 種 類 ) :

Address
(( 地 址 ) :

Tel. No. Fax No.

((電話) :__________________________(圖文傳真) :
Contact Person (Full Name) (Capacity)
(( 聯 絡 人 ) : ( 全名 ) : (職 位 ) :

C. D
0eclaration 1 hereby certify that the particulars given above are correct and true to the best of my knowledge
聲 明 and belief.
據本人所知及所信，上文所開列的資料，全屬真確無訛，此證。

________________________________ ________________________________
Signature (簽名) ( Company chop (公司印鑑
where appropriate 如適用者)

________________________________ _________________ _____________

( Name in block letters (正楷姓名) (( Capacity (職位) ( Date(R期)

WARNING : Any person(s) who knowingly or recklessly provide incorrecl or misleading informalion or omil malerial parliculars or informalion or
knowingly or recklessly cerlify as correcl anylhing which is incorrecl， in relalion lo any requiremenl in lhe regulalions， commils an
offence punishable wilh a maximum fine of $200，000 and imprisonmenl for 6 monlhs.
警 告:根據廢物處置(化學廢物) (一般)規例的規定，任何人士填報本表格時故意或罔顧後呆地提供不確或誤導資料或遺漏重要事項，叉或故意
或罔顧後呆地證明任何不確事項為正確，且屬違法，最高可被判罰款港幣 200，000 元及入獄 6 個月。
EPD 129
EXPLANATORY NOTES 註 釋

Part A 主((直
直
Enter full particulars of the waste producer. The applicant 填上廢物產生者的詳細資料。中請人可以是個人，法人團
may be an individual， a person on behalf of a body corporate，
or one of the partners of a partnership. The complete 體的技權人，或合夥公司的其中一名合夥人。請填上完整
Business Registration Certificate No. coding in the format of 的商業登記證編號，其格式應為

should be entered. For ease of computer data entry， if 為方便電腦存梢，可以的話，請以英文填寫通訊地址。

possible， please enter your correspondence address in
English.
旦((直
直
Part 且
Name of Establishment and B.R.C. No.
機構名稱及商業登記

Enter the name of your establishment in full and the complete 填上貴機構的全名及完整商業登記證編號(如適用)。倘若
business registration certificate number， if applicable. If 產生廢物的地點或樓宇超過一個，請列出所有關機構的地
there are more than one establishment， list out all of them
點或樓宇名稱(可另加紙書寫)。
(use separate sheet if necessary).

Nature of Business 業務性質

Enter the nature of business of establishment(s). For an
填上貴機構所從事的業務性臂。就工業機構而言，填上主
industrial establishment， the major product type(s) and the
nature of process(es) involved should also be specified. For 要產品的類別及所涉及的工序性臂。例如，製造五金玩具
example， manufacture of metal toys - electroplating. 電鏈。

Major Chemical Waste Types

主要化學廢物種類
Set out the major types of chemical waste generated or
expected to be generated at the establishment(s). For 填上貴機構所產生或將會產生的主要化學廢物種類。例
example， spent acid， solvent waste， waste lubricating oil etc.
如:廢酸、廢溶劑、廢潤滑油等。請約略說明廢物產生的
Please describe briefly whether your chemical wastes are
generated on a regular or occasional basis. 頻度為何，是經常性或非經常性。

Address
地址
For ease of computer data entry， if possible， please enter the
address(es) of the establishment(s) in English. 為方便電腦存梢，可以的話，請以英文填上貴機構的地址。

Particulars of Contact Person

Enter the full particulars i.e. Tel. No.， Fax No.， Full Name(both 聯絡人資料
English and Chinese please) and Capacity of the contact
person(s) who would be responsible for day-to-day 填上負責登記事宜的聯絡人詳細資料，例如電話，圖文傳
supervision. 真號碼，中英文姓名及職位。

Part C
C((直
直
If the waste producer is an individual， the declaration must be
signed by the same one who applies for registration. In the 倘若廢物產生者為個人，聲明一欄須向中請登記者本人簽
case of a company or an organisation， this part must be
署。若以公司或團體組織名義中請，此部份應向獲該公司
signed by a person authorized by the company or the
organisation， as the case may be. If the waste producer is a 或組織技權的人士簽署。若廢物產生者為合夥人，則應向
partnership， it should be signed by one of the partners. 其中一名合夥人簽署。請以正楷填寫簽署人的中英文名
Please use block letters for filling in both the corresponding
字。
English and Chinese name.

Note: 1. Please return the completed application form to

Environmental Protection Department at the
留意:1. 請把填妥的中請表交回環境保護署以下地址:
following address:

( ( ( 28th(Floor，(Southorn(Centre，
( ( ( 130(Hennessy(Road，(Wan(Chai，(Hong Kong. 香港灣仔軒尼詩道 百三十號
百三十號

修頓中心廿八樓
修頓中心廿八樓

 Personal Tnformation Collection Statement

P且rnose of Collection
1. The personal data provided by means of this form will be used by Environmental Protection Department for
one or more of the following purposes:
a. activities relating to the processing of your submission in this form;
b. administration and enforcement of relevant environmental legislation;
c. pollution complaint investigations;
d. statistical and any other legitimate purposes; and
e. to facilitate communications between Government and yourself.

2. The provision of personal data by means of this form is voluntary. If you do not provide sufficient
information， we may not be able to process your application.

Classes of ransferees
3. The personal data you provided by means of this form:

(i) may be disclosed to:

a. other government bureaux and departments， and any other organisations for the purposes mentioned
in paragraph 1 above， and
b. other persons as permitted by the relevant legislation;

(ii) and will be disclosed in a register open for inspection by the public for the purpose of making
representations about the control and regulation of the production， storage， collection and disposal
including the treatment， reprocessing and recycling of chemical waste， the licensing and registration of
places and persons connected with any such activity， or the protection and safety of the public in relation to
any such activity.

Access to Personal Oata

4. You have a right of access and correction with respect to personal data as provided for in section 18 and 22
and principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance. Your right of access includes the right to obtain
a copy of your personal data provided by this form.

耳n 且iries
5. Enquiries concerning the personal data collected by means of this form， including the making of access and
corrections， should be addressed to:
Senior Environmental Protection Officer (Management Support)
28/F， Southorn Centre
130 Hennessy Road
Wanchai
Hong Kong
Tel: 2835 1330
Fax: 2834 8845

EPD129 PICS
 個人資料收集聲明

收集個人資料的目的
1. 你在這份表格上提供的資料，環保署將用於下列一項或多項用途:
a. 與處理本表格申請事項有關的工作;
b. 有關環境法例的執行和執法;
c. 污染投訴調查;
d. 統計及其他法定用途;以及
e. 方便政府跟你聯絡。

2. 是否在本表格上提供個人資料，純屬自願性質。如果你不提供足夠的資料，本署未必可以處理你的申請。

獲轉交個人資料人士的類別
3. 你在本表格上提供的個人資料，本署

(i) 可向下列人士按露:

a. 索取該等資料以作上文第 1 段用途的其他政府決策局及部門;以及
b. 按有關法例獲准的其他人士;

(ii) 以及會在一登記冊上按露，公開給公泉查閱，以作用於申述有關管制及規管化學廢物的產生、財存、收
集及處置(包括處理、再加工、循環再造)、該等活動的地方及人士的發脾及登記、該等活動的公康的
保護及安全。

查閱個人資料
4. 根據個人資料(私隱)條例第 18 條及第 22 條及附表 1 第 6 原則的規定，你有權查閱和更改個人資料。你
查閱個人資料的權利，包括取得在這份表格上提供的個人資料副本。

查詢
5. 如欲查詢經本表格填報的個人資料，包括查閱和更改個人資料，可去信:
香港灣仔軒尼詩道 130 號修頓中心 28 樓
高級環境保護主任(管理支援)
(電話:2835 1330
傳真:2834 8845)

EPD129 PICS