香港特別行政區政府

表格 Form
The Government of the
Hong Kong Special Administrative Region RA-6
環 境 保 護 署 Environmental Protection Department

產 品 環 保 責 任 (受 規 管 物 品 ) 規 例
PRODUCT ECO-RESPONSIBILITY (REGULATED ARTICLES) REGULATION
申請憑減少容器廢物計劃獲取豁免
Application for Exemption with Container Waste Reduction Plan
注意 在填寫本表格前，請先參閱「供應商須知」 。請用正楷填寫，並在適當方格內填上 ✓ 號及在標註 * 號的項目刪去不適用者。
NOTE Please read the “Notes to Suppliers” before completing this form. Please complete in BLOCK LETTERS, and enter ✓ in the appropriate
boxes and delete inapplicable items marked with *.

登記供應商名稱：
Name of Registered Supplier:

登記號碼：
Registration No.: EP-RA ___ ___ - O - ___ ___ ___ ___

本人／我們現根據《產品環保責任條例》(第 603 章)第 56(1)條，就某類型的受規管物品申請豁免，

不受該條例第 51、52 及 53 條所規限，並附上一份「減少容器廢物計劃」，指明有關受規管物品的
容器的回收和重用，以及當容器不再適合重用時有關循環再造的安排。
I/We, in accordance with Section 56(1) of Product Eco-responsibility Ordinance (Cap. 603), apply for
exmeption from Sections 51, 52 and 53 in relation to certain type(s) of regulated articles. I/We hereby attach
a Container Waste Reduction Plan specifying the arrangement for the recovery and reuse of the containers
of the regulated articles concerned, and where the containers are no longer suitable for reuse, the recycling
arrangement.

本人／我們確認上述申請已附有 –
I/we confirm that the above application is accompanied by –

□ 申請費 (費用為港幣 9,250 元，請用劃線支票繳付，支票抬頭請書「香港特別行政區政府」。

繳付的申請費用概不發還。)；及
Application fee (The fee is HK$9,250. Please pay by crossed cheque payable to “The Government of
the Hong Kong Special Administrative Region”. The application fee paid is non-refundable.); and

□ 「減少容器廢物計劃」及相關證明文件。
Container Waste Reduction Plan and relevant supporting documents.

RA-6 (6/2023) 1
 甲部 豁免申請涵蓋的受規管物品的詳情
Part A Details of Regulated Articles Covered by Exemption Application
品牌名稱
Brand Name
產品名稱
Product Name
飲料類別
Type of Beverage
容器容積 (毫升)
Container Volume (mL)
受規管物品的相片
Photos of Regulated Articles

識別標誌或措施
(如適用，以區分豁免申請涵蓋的受規
管物品及其他類似但不被豁免申請涵
蓋的受規管物品)
Identification Marks or Measures
(if applicable, to differentiate the
Regulated Articles covered by the
exemption application from other similar
Regulated Articles not covered by the
exemption application)

RA-6 (6/2023) 2
 甲部 豁免申請涵蓋的受規管物品的詳情 (續)
Part A Details of Regulated Articles Covered by Exemption Application (Con’t)
過去 12 個月受規管物 期間 Period
品的分銷渠道及銷售 由 from ______ / ______ / _________ 至 to ______ / ______ / _________
容積
(日 dd / 月 mm / 年 yyyy) (日 dd / 月 mm / 年 yyyy)
Distribution Channel
and Sales Volume of □ 餐飲 Catering
Regulated Articles in
Past 12 Months • 銷售點數目
Number of Sales Outlets
• 銷售容積 (公升)
Sales Volume (L)
□ 零售 Retailing
• 銷售點數目
Number of Sales Outlets
• 銷售容積 (公升)
Sales Volume (L)
□ 其他 Others
(請註明) (Please specify)
• 銷售點數目
Number of Sales Outlets
• 銷售容積 (公升)
Sales Volume (L)

過去 12 個月的減廢率 期間 Period
(如設有回收重用安排) 由 from ______ / ______ / _________ 至 to ______ / ______ / _________
Waste Reduction Rate (日 dd / 月 mm / 年 yyyy) (日 dd / 月 mm / 年 yyyy)
in Past 12 Months
(if recovery and reuse 總銷售量 (瓶) (a) (公升)
arrangement available) Total Sales Volume (Bottle) (L)
容器回收量 (瓶) (b) (公升)
Recovery Quantity of Containers (Bottle) (L)
減廢率 (b) ÷ (a)
Waste Reduction Rate
(%)
預計設有減少容器廢 期間 Period
物計劃後首 12 個月的 由 from ______ / ______ / _________ 至 to ______ / ______ / _________
減廢率
(日 dd / 月 mm / 年 yyyy) (日 dd / 月 mm / 年 yyyy)
Estimated Waste
Reduction Rate in 總銷售量 (瓶) (a) (公升)
First 12 Months with Total Sales Volume (Bottle) (L)
Container Waste
容器回收量 (瓶) (b) (公升)
Reduction Plan in
Place Recovery Quantity of Containers (Bottle) (L)
減廢率 (b) ÷ (a)
Waste Reduction Rate
(%)
如豁免申請涵蓋其他受規管物品，請影印或從互聯網下載甲部繼續填寫。Please continue on a photocopy or downloaded copy
of Part A if there are other regulated article covered by the exemption application.
RA-6 (6/2023) 3
 乙部 登記供應商聲明
Part B Declaration of Registered Supplier

*本人／我們謹此聲明，盡*本人／我們所知所信，根據本表格所提供的資料皆為真確及完整。

*本人／我們已細閱「供應商須知」及關於*本人／我們個人資料的「個人資料收集聲明」。*本人／
我們謹此聲明，*本人／我們在此申請表上所填報的個人資料，就*本人／我們所知，均屬真確及最
新的資料。*本人／我們明白並且同意，此等個人資料，可按照「個人資料收集聲明」所述之目的而
被使用。

*I/We declare that the information provided in this form is, to the best of *my/our knowledge and belief,
true and complete.

*I/We have read the Notes to Suppliers and Personal Information Collection Statement about *my/our
personal data. *I/We declare that the personal data provided in this application form are accurate and up-
to-date to the best of *my/our knowledge. *I/We agree and understand that such personal data can be used
according to the purposes stated in the Personal Information Collection Statement.

（簽署 Signature） （姓名 Name） （職位 Capacity）

代表 on behalf of :

（公司名稱及印鑑 Company Name and Chop) （日期 Date）

（如適用者 if appropriate）

警告：
根據香港法例第 603 章《產品環保責任條例》第 9(1)條規定：
 任何人出示或提供在要項上屬虛假或具誤導性的紀錄、文件或資料，充作遵守本條例，即屬犯罪，一經定罪，可處第 6 級罰
款（十萬港元）
。
根據香港法例第 603 章《產品環保責任條例》第 9(3)條規定：
 任何人無合理辯解而在出示或提供根據本條例規定他須出示或提供的紀錄、文件或資料時遺漏任何要項，即屬犯罪，一經定
罪，可處第 6 級罰款（十萬港元）
。

Warning:
Under Section 9(1) of the Product Eco-responsibility Ordinance (Cap. 603):
 A person who, in purported compliance with this Ordinance, produces or provides any record, document or information that is false or
misleading in any material particular commits an offence and is liable on conviction to a fine at level 6 (HK$100,000).
Under Section 9(3) of the Product Eco-responsibility Ordinance (Cap. 603):
 A person who, without reasonable excuse, omits any material particular from any record, document or information required to be produced
or provided by him under this Ordinance commits an offence and is liable on conviction to a fine at level 6 (HK$100,000).

RA-6 (6/2023) 4
 供應商須知
1 申請確認
本署在收到申請後，會以郵寄或電郵方式確認。

2 一般事項
如表格內的空間不足以列明各項資料，可影印或從互聯網下載該頁繼續填寫，並於每頁另加紙張的空白位置，加
上頁碼及登記供應商的簽署或公司印章。
3 重要事項提示
(a) 如有以下情況，本署須拒絕申請 ——
(i) 本署認為「減少容器廢物計劃」並非切實可行；
(ii) 本署認為「減少容器廢物計劃」不能確保可藉合乎環境衞生的方式，回收和再使用或循環再造有關容器；
(iii) 申請並非採用指明表格提出；
(iv) 如在申請被撤回或有決定前，就該項申請向本署提供的資料有所變更，申請人沒有在知悉該項變更當日
後的 7 日期間完結前，將該項變更以書面通知本署；
(v) 申請人沒有遵從本署給予的書面通知，就申請提供進一步資料及文件；或
(vi) 就申請提供的任何關鍵資料屬不正確或具誤導性。
(b) 本署可在關乎以下事宜的任何條款及條件的規限下，授予有關豁免——
(i) 該豁免的有效期；
(ii) 有關減少容器廢物計劃的實施；
(iii) 審計、報告及紀錄備存；及
(iv) 本署認為合適的任何其他事宜。

4 查詢
如有任何疑問，可透過電話 (2838 3111)、傳真 (2318 1877)、電郵 ([email protected]) 或郵寄 (地址：香港金鐘
道 66 號金鐘道政府合署高座 21 樓；信封面註明「玻璃飲料容器計劃」） ，向本署查詢。

Notes to Suppliers
1 Acknowledgement
Upon receipt of the application form, this Department will issue an acknowledgement note by post or by email.

2 General
If there is not enough space to fill in all the information, you may continue on a photocopy or download copy of the pages,
which are to be numbered and duly signed by the registered supplier, or stamped by the company chop on each page.

3 Important Points for Attention

(a) This Department must refuse an application if—
(i) this Department considers that the container waste reduction plan is impracticable;
(ii) this Department considers that the container waste reduction plan cannot ensure the recovery and reuse or
recycling of the containers concerned in an environmentally sound manner;
(iii) the application is not made in the specified form;
(iv) before the application is withdrawn or determined, a change in the information provided to this Department for
the application occurs, the applicant does not, before the end of the period of 7 days after the day on which the
change comes to the notice of the applicant, give this Department a written notice of the change;
(v) the applicant does not provide further information and documents for the application according to written notice
from this Department; or
(vi) any material information provided for the application is incorrect or misleading.
(b) This Department may grant the exemption subject to any terms and conditions relating to—
(i) its duration;
(ii) the implementation of the container waste reduction plan;
(iii) auditing, reporting and record keeping; and
(iv) any other matter this Department considers appropriate.

4 Enquiries
For enquiries, please contact this Department by telephone (2838 3111), by fax (2318 1877), by e-mail
([email protected]) or by post (address: 21/F, High Block, Queensway Government Offices, No. 66 Queensway, Hong
Kong; please specify on the envelope “GPRS”).

RA-6 (6/2023) 5
 遞交申請

郵寄: 將填妥的表格連同有關文件的副本郵寄至下列地址，並於信封面註明：「玻璃飲料容器計劃」

香港金鐘道 66 號
金鐘道政府合署高座 21 樓
環境保護署

親身提交: 將填妥的表格連同有關文件的副本（載於信封內）
，並於辦公時間（星期一至五上午九時至下午五時）
交到下列本署辦事處：

辦事處 地址 電話

稅務大樓辦事處 香港灣仔告士打道 5 號稅務大樓 33 樓 2824 3773

長沙灣政府合署辦事處 九龍長沙灣道 303 號長沙灣政府合署 8 樓 2402 5200

區域辦事處 (東) 九龍九龍灣臨樂街 19 號南豐商業中心 5 樓 2755 5518

區域辦事處 (南) 香港鰂魚涌海灣街 1 號華懋交易廣場 2 樓 2516 1718

區域辦事處 (西) 新界荃灣西樓角路 38 號荃灣政府合署 8 樓 2417 6116

區域辦事處 (北) 新界沙田上禾輋路 1 號沙田政府合署 10 樓 2158 5757

Submission of Application
By post: The completed application form together with copies of relevant documents can be sent by post to the following
address. Please specify on the envelope: “GPRS”

Environmental Protection Department

21/F, High Block, Queensway Government Offices,
No. 66 Queensway, Hong Kong

In person: The completed application form together with copies of relevant documents (put in envelope) can be submitted
in person during office hours (Monday to Friday, 9:00am to 5:00pm) to the offices of this Department:

Office Address Telephone

Revenue Tower Office 33/F., Revenue Tower, 5 Gloucester Road, Wanchai, Hong Kong 2824 3773
Cheung Sha Wan 8/F., Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon 2402 5200
Government Offices
Regional Office (East) 5/F., Nan Fung Commercial Centre, 19 Lam Lok Street, Kowloon Bay, Kowloon 2755 5518
Regional Office (South) 2/F., Chinachem Exchange Square, 1 Hoi Wan Street, Quarry Bay, Hong Kong 2516 1718
Regional Office (West) 8/F., Tsuen Wan Government Offices, 38 Sai Lau Kok Road, Tsuen Wan, NT 2417 6116
Regional Office (North) 10/F., Sha Tin Government Offices, 1 Sheung Wo Che Road, Sha Tin, NT 2158 5757

RA-6 (6/2023) 6
 個人資料收集聲明

收集個人資料的目的
1. 收集個人資料的目的，在於處理《產品環保責任條例》下你向環境保護署(環保署)提交的呈報。
2. 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：
i. 與處理本表格申請事項有關的工作；
ii. 有關環境法例的執行、執法和檢舉；
iii. 投訴調查；
iv. 統計及其他法定用途；及
v. 方便政府跟你聯絡。
3. 在本表格上提供個人資料，純屬自願性質。如果提供的資料不足夠，環保署未必可以處理這項呈報。

可能移轉資料
4. 你在這份表格上就有關呈報所提供的個人資料，環保署可向下列人士披露：
i. 其他政府決策局及部門以供處理上文第 2 段事項；及
ii. 按有關法例獲准的其他人士。

查閱和更改個人資料
5. 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，包括取得資料副本。

查詢
6. 如有任何疑問，可透過致電(2838 3111)、傳真(2318 1877)、電郵([email protected])或郵寄(地址：香港金鐘道 66 號
金鐘道政府合署高座 21 樓)，向環保署辦事處查詢；信封面請註明「玻璃飲料容器計劃」。

Personal Information Collection Statement

Purpose of Collection
1. The personal data in relation to this form will be used for the purpose of processing your submission to the Environmental
Protection Department (EPD) under the Product Eco-responsibility Ordinance.
2. The personal data provided in this form may be used by the EPD for one or more of the following purposes:
i. activities relating to processing this application;
ii. administration, enforcement and prosecution of relevant environmental legislation;
iii. complaint investigations;
iv. statistical and any other legitimate purposes; and
v. facilitating communications between the Government and you.
3. The provision of personal data by means of this form is voluntary. If the information provided is not sufficient, the EPD may
not be able to process this submission.

Transfer of Personal Data

4. The EPD may disclose the personal data provided in this submission to:
i. other government bureaux and departments for the purposes mentioned in paragraph 2 above; and
ii. other persons as permitted by the relevant legislation.

Access to and Correction of Personal Data

5. 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. The right of access includes the right to obtain a copy of personal
data provided by you.

Enquiries
6. For enquiries, please contact the EPD office by phone (2838 3111), by fax (2318 1877), by e-mail ([email protected]) or
by post (address: 21/F, High Block, Queensway Government Offices, No. 66 Queensway, Hong Kong). For letters, please
specify on the envelope “GPRS”.

RA-6 (6/2023) 7