香港特別行政區政府

The Government of the Hong Kong Special Administrative Region

《 汞 管 制 條 例 》 (第 640 章 )
Mercury Control Ordinance (Chapter 640)

申 請 *發 出 管 有 許 可 證 ／ 將 管 有 許 可 證 續 期
Application for *issue / renew of possession permit

1. 申 請 人 資 料 Particulars of Applicant

申請人名稱 (個人或公司) Name of Applicant (person or company)

(英文 English): _______________________________________________________________________________

(中文 Chinese):

商業登記號碼 (如有)
Business Registration Certificate No. (if any):

香港身份證╱護照 * 號碼 (如由個人申請)
H.K.I.D. Card / Passport * No. (for application made by a person only): __________________________________

申請人地址 (如申請人是公司，請在此欄提供公司註冊地址)
Applicant’s Address (if applicant is a company, please provide the registered address of the company below):

通訊地址 (如與申請人地址不同)
Correspondence Address (if different from the applicant’s address):

電話號碼 傳真號碼
Telephone No.: Fax No.:

聯絡人姓名 聯絡人職位
Name of Contact Person: Position of Contact Person:

聯絡人電話號碼 電郵地址
Contact Person’s Telephone No.: Email Address: _________________________________

業務性質
Business Nature:

現時許可證號碼 (如申請許可證續期)
Current Permit No. (for permit renewal only): _______________________________________________________

現有許可證屆滿日期 (如申請許可證續期)
Current Permit Expiry Date (for permit renewal only): ________________________________________________

* 請刪去不適用者 Please delete if not applicable

EPD MCO3 (11/2021) 第 一 頁／Page 1

2. 擬管 有 一 批 第 2 部 化 學 品 的 詳 細 資 料
Details of the Batch of Part 2 Chemicals to be Possessed

第 2 部化學品 存放量(千克) 使用量(千克)

Part 2 chemicals Quantities to be kept (kg): Quantities to be used (kg):

(1) 汞 Mercury
(CAS No. :7439-97-6)
(2) 汞混合物 Mercury mixture^

(3) 氯化亞汞(I) Mercury(I) chloride

(CAS No. : 10112-91-1)
(4) 氧化汞(II) Mercury(II) oxide
(CAS No. : 21908-53-2)
(5) 硫酸汞(II) Mercury(II) sulphate
(CAS No. : 7783-35-9)
(6) 硝酸汞(II) Mercury(II) nitrate
(CAS No. : 10045-94-0 or 7783-34-8)
(7) 硫化汞 Mercury sulphide
(CAS No. : 1344-48-5)
(8) 朱砂 Cinnabar
該批第 2 部化學品的用途*：
Purpose of the batch of Part 2 chemicals *:

該批第 2 部化學品的進口商、存放者和使用者資料*：
Particulars of the importer, keeper and user of the batch of Part 2 chemicals*:

該批第 2 部化學品的存放處所地址*：
Address of the premises where the batch of Part 2 chemicals to be kept*:

該批第 2 部化學品的使用處所地址*：
Address of the premises where the batch of Part 2 chemicals to be used*:

該批第 2 部化學品的儲存方式*：
Storage method of the batch of Part 2 chemicals to be possessed*:

與該批第 2 部化學品相關的存放及使用操作摘要*：
Operation brief for in relation to the keeping and use of the batch of Part 2 chemicals to be possessed*:

^汞混合物 (mercury mixture) 指汞與其他物質的混合物 (包括汞的合金)，而該混合物的汞含量按重量計至少達 95%

Mercury mixture means a mixture, having a mercury concentration of at least 95% by weight, of mercury and other substances (including alloys of mercury)
*提供相關文件證明。
Please provide supporting documents.

EPD MCO3 (11/2021) 第 二 頁／Page 2

3. 申 請 人 聲 明 Applicant’s Declaration

據本人所知及所信，於此申請表中所提供的資料，包括附件中的資料，全屬真實無訛，此證。
I hereby certify that the particulars given under this application including those in the Annexes are correct and true to
the best of my knowledge and belief.

______________________________________________ __________________________________________
姓名(正楷) Full Name (in Block Letters) 職位 Capacity

_____________________________________________ ____________________________________________
簽名 Signature 公司印章 (如適用) Company Chop (if applicable)

日期 Date:

申請表格上每一項均須填寫。填妥的申請表格，應連同下列文件遞交或郵寄到香港灣仔皇后大道東 183 號合和

中心 34 樓 3404 室環保署總區辦事處﹝汞管制課﹞：
(1) (i) 如申請人為有限公司，請提供商業登記證影印本一份；或
(ii) 如申請人為無限公司，請提供商業登記證影印本一份、東主身份證或護照影印本一份；或
(iii) 如申請人以個人身份申請，請提供申請人身份證或護照影印本一份；及
(2) 申請表格第 2 頁所提供資料的相關文件證明；及
(3) 有關第2部化學品的存放及使用的操作摘要，該摘要應包括以下資料：
(a) 以合適比例顯示設施要點的設計圖；
(b) 涉及使用第2部化學品的設施的主要操作程序，包括與使用第2部化學品有關的工序流程圖；
(c) 第2部化學品庫存及使用的紀錄安排；
(d) 存放第2部化學品方法，如容器或包裝及其標籤、存放間隔安排；
(e) 設施為防止第2部化學品溢漏和污染而採納的措施；

(f) 遇意外溢漏、緊急情況或設施發生事故或機件出現故障時，處理第2部化學品及有關物料的應變

措施；
(g) 設施的安全設備及措施，如個人防護裝備及通風系統；
(h) 設施的保安安排；

(i) 處置廢棄的第2部化學品及其副產物的方法，如適用；
(j) 處理第2部化學品人員的管理架構；

(k) 各政府部門對該設施所簽發的有效牌照、許可證或豁免證明的影印本一份，如適用；
(l) 需要存放或使用第2部化學品的理據；和
(m) 對設施可能排放或釋放的第2部化學品的監測措施（包括廢物、污水和廢氣）
。
Every section on the application form must be completed. The completed form should be submitted by hand or by
post to Territorial Control Office (Mercury Control Section), Environmental Protection Department, Room 3404, 34/F,
Hopewell Centre, 183 Queen's Road East, Wan Chai, Hong Kong together with the following documents:

EPD MCO3 (11/2021) 第 三 頁／Page 3

 (1) (i) a copy of the Business Registration Certificate if the application is made by a limited company; or
(ii) a copy of the Business Registration Certificate, a copy of the business owner’s Hong Kong Identity
Card or Passport if the application is made by an unlimited company; or
(iii) a copy of the applicant’s Hong Kong Identity Card or passport if the application is made by a person;
and
(2) supporting documents for the information provided on page 2 of this application form; and
(3) an operation brief of the facility related to the keeping and use of the Part 2 chemicals. The operation brief
should include the following information:
(a) a layout plan on an appropriate scale showing the key features of the facility;
(b) key operating procedure of the facility involving the Part 2 chemicals, including a work flow diagram

showing the processes related to the use of the Part 2 chemicals;

(c) record keeping arrangement for the stock and usage of the Part 2 chemicals;
(d) means of storing the Part 2 chemicals, such as storing it in containers or packages and the labelling

and storage partition arrangement;

(e) measures adopted by the facility to prevent the Part 2 chemicals from spilling and causing pollution;
(f) contingency measures to deal with the Part 2 chemicals and related material(s) in the event of

accidental spillage, emergency, or breakdown or mechanical failure of the facility;

(g) safety equipment and measures provided in the facility, such as personal protective equipment and

ventilation systems;
(h) security arrangements of the facility;
(i) means of disposing of the waste Part 2 chemicals or their by-products, if applicable;
(j) management structure of the staff handling the Part 2 chemicals;
(k) a copy of the valid licences, permits or exemptions issued by government departments for the facility,

if applicable;
(l) justifications for keeping or using the Part 2 Chemical;
(m) measures to monitor the potential emission or release of the Part 2 Chemical from the facility

(including waste, wastewater and emissions).

警告：根據《汞管制條例》第 63 條，任何人如 (a) 為根據本條例提出的申請的目的，向公職人員提供任何資料；

或向公職人員提供任何資料，充作遵從某規管性規定；(b) 該資料在某要項上屬虛假或具誤導性；及 (c) 該人知
道該資料在該要項上屬虛假或具誤導性，或罔顧該資料是否在該要項上屬虛假或具誤導性，即屬犯罪，一經定罪，
可處罰款$10,000 及監禁 6 個月，除非該人根據《條例》第 67 或第 68 條採取合理步驟作免責辯護。
Warning: Under section 63 of Mercury Control Ordinance (Cap. 640), any person who (a) provides any information
to a public officer for the purpose of an application under this Ordinance; or in purported compliance with a
regulatory requirement; (b) the information is false or misleading in a material particular; and (c) the person knows
that, or is reckless as to whether, the information is false or misleading in that material particular, commits an
offence. That person shall be guilty of an offence and shall be liable on conviction to a fine of $10,000 and to
imprisonment for 6 months unless he/ she has taken all reasonable steps to establish a defence under sections 67 or
68 of the MCO.

EPD MCO3 (11/2021) 第 四 頁／Page 4

 Personal Information Collection Statement
(for General Application)

Purpose 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 Transferees
3. The personal data you provided by means of this form 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.

Access to Personal Data

4. 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 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.

Enquiries
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 (Knowledge Management)
Room1201, Guardian House
32 Oi Kwan Road
Wan Chai
Hong Kong
Tel: (852) 2838 3111 Fax: (852) 2838 3111

個人資料收集聲明
(一般申請用)

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，本署可向下列人士披露：
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。

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：
香港灣仔愛群道32號愛群商業大廈1201室
高級環境保護主任（知識管理）
電話：(852) 2838 3111 傳真：(852) 2838 3111