墳場及火葬場組

CEMETERIES & CREMATORIA SECTION

申請流產胎（定義為「非活產嬰兒」1以外的流產胎）安放服務
Application for Service for Keeping of Abortus (defined as Abortus that is NOT “Still-birth”1)

（甲部）申請事項及詳情 (Section A) Particulars of Application

請只填選一項。 Please tick one item only.

 在安放設施安放流產胎及安裝紀念牌匾
Keeping of abortus and mounting a commemorative plaque at the keeping facility

 只在安放設施安放流產胎
Only keeping of abortus at the keeping facility

（乙部）申請有關服務的擬安放地點 (Section B) Intended Keeping Place of the Service

擬安放流產胎的地點：
Intended Place for Keeping of Abortus

（丙部）申請人資料 (Section C) Particulars of Applicant

申請人姓名： （中文） （英文）  先生／  女士

Name of Applicant (Chinese) (English) Mr. Ms.

中文電碼：  香港身分證號碼／ 護照號碼：

Chinese Commercial Code HKID Card No. Passport No.

電話號碼： 流動電話號碼^：
Tel. No. Mobile Phone No. ^

與流產胎關係：
Relationship with the Abortus

聯絡地址：
Correspondence Address
 香港 HK／ 九龍 Kln／ 新界 NT
 本人以中文為日後的通訊語言。  I would use English for future correspondence.
^註： 為支持環保，本人同意食物環境衞生署（食環署）以WhatsApp／電話短訊形式通知有關申請結果及作日後通訊之用，而不再另行發出書
面通知。請注意，如你欲以郵寄方式接收申請結果／日後通訊，請在以下方格填上「」號。
Note: In support of environmental protection, I agree that the Food and Environmental Hygiene Department (FEHD) will notify the application results
and for future communications by WhatsApp/phone short message without further written notification. Please note that if you wish to receive
the application results/future communications by post, please tick the box below.
 本人欲以郵寄方式接收食環署發出的通知／訊息。 I wish to receive notification/message from the FEHD by post.

（丁部）流產胎母親資料（只適用於申請人並非流產胎母親）
(Section D) Particulars of Mother of Abortus (only applicable when the applicant is NOT the mother of abortus)

流產胎母親姓名： （中文） （英文）

Name of Mother of Abortus (Chinese) (English)

中文電碼：  香港身分證號碼／ 護照號碼：

Chinese Commercial Code HKID Card No. Passport No.

1
「非活產嬰兒」定義為獲發根據《生死登記條例》（第 174 章）表格 13 所指的嬰兒非活產證明書的流產胎。
“Still-birth” is defined as abortus that has been issued with a Certificate of Still-birth referred to as Form 13 under the Births and Deaths Registration
Ordinance (Cap. 174).

 請在適當的方格內填上「」號。 Please tick the appropriate box.

FEHB 282 (11/2023) 1
（戊部）流產胎資料 (Section E) Particulars of the Abortus

流產胎姓名2（如有） ： （中文） （英文）

Name of the Abortus2 (if any) (Chinese) (English)

流產日期： ／ ／ 懷孕週數：
Date of Abortion 日 DD 月 MM 年 YYYY Week of Gestation

流產地點（醫院／醫療機構名稱）：
Place of Abortion (Name of Hospital/Healthcare Facility)
證明文件：  流產胎文件  其他（請註明） ：
Documentary Proof Documentation on Abortus Others (please specify)

食環署可為流產胎在「無盡思念」網站免費開設專屬紀念網頁（請參閱附件第 4 項） 。如欲獲得有關服務，請提供電郵
地址及表示同意如下：
FEHD may create a dedicated memorial webpage for the abortus at the Internet Memorial Service free of charge (please read
item 4 of Annex). If you wish to receive the service, please provide your email address and indicate your consent below:

 本人同意貴署使用我的電郵地址作上述用途。 電郵地址：___________________________________
I agree to the use of my email address by the Department for Email Address
the above purpose.

（己部）申請人聲明 (Section F) Declaration by Applicant

謹此聲明，就本人所知所信，在本申請表格所填報的資料，均屬真實無訛。本人明白，如填報的資料經查明失實
或作出虛假聲明，本申請將不獲批准，如已獲批准亦將會被撤回。本人也可能須為虛假資料或聲明負上相關的法律責
任。本人並同意遵守食環署所訂立使用安放設施的服務要求及條件（見附件）
。如本人的聯絡資料日後有所更改，本人
須適時通知食環署。
I hereby declare that to the best of my knowledge and belief all the information contained in this application form is true
and correct. I understand that this application will not be approved or such approval if given will be revoked if I have given
false information or made a false declaration. Also, I may be held liable for any consequences of giving false information or
making false declaration. I shall observe the service requirements and conditions for using the keeping facility (see Annex)
stipulated by FEHD. If there is any change in my contact information in the future, I should update FEHD as appropriate.

日期： ／ ／
Date 日 DD 月 MM 年 YYYY 申請人簽署
Signature of Applicant

此欄只供辦事處填寫 FOR OFFICE USE ONLY

查核人員：
Checked by 日期（日／月／年） 查核人員簽署 查核人員姓名及職位
Date (dd/mm/yyyy) Signature of Checking Officer Name and Post Title of
Checking Officer

核准人員：
Approved by 日期（日／月／年） 核准人員簽署 衞生督察姓名及職位
Date (dd/mm/yyyy) Signature of Approving Officer Name and Post of Health Inspector

內部參考編號：
Internal Reference No.

2
必須與證明文件上的流產胎姓名相符（如有）
。 Must be identical to that stated in the documentary proof (if any).
 請在適當的方格內填上「」號。 Please tick the appropriate box.

FEHB 282 (11/2023) 2

 附件 Annex
申請及服務須知 Notes for Application and Service
1. 本表格不收費用，這項安放服務的費用全免，但申請人須自行購買及安裝紀念牌匾（如有需要）。
No fee is charged for this form, this keeping service is free of charge; however, the applicant shall purchase and mount the
commemorative plaque by herself/himself (if required).
2. 申請人與食環署進行任何事務往來時均不得向食環署人員提供任何利益。
Applicant, while having dealings of any kind of service with FEHD, should not offer any advantage to FEHD officers.
3. 凡符合下列準則的流產胎，均可申請在食環署轄下的流產胎安放設施安放：
An abortus meeting the following criteria is eligible to apply for keeping facility for abortuses of FEHD:
 持有由本地醫生或醫院或註冊醫療機構簽發的「流產胎文件」或其他證明文件，其父及／或母為香港居民的
流產胎。
Abortus, with “Documentation on Abortus” or other documentary proof issued by a local medical practitioner or
hospital or registered healthcare facility and the father and/or mother concerned is/are resident(s) of Hong Kong.
4. 申請人必須填寫本表格的甲、乙、丙、丁（如適用） 、戊及己部。
Applicant should complete Sections A, B, C, D(if applicable), E and F of this form.
有意為流產胎在「無盡思念」網站 ([Link]) 開設紀念網頁的申請人只需填寫電郵地址。食環署會預設一
個載有流產胎姓名（如申請服務時未能提供流產胎姓名，流產胎姓名會預設為有關母親之流產胎，即「XXX 之流
產胎」 ）及流產日期的專屬紀念網頁，並於使用流產安放服務後兩個工作天內發出確認通知電郵，以便申請人隨時
啓動戶口及登入紀念網頁編輯網頁內容。網上追思服務費用全免。
Applicant interested in creating a memorial webpage at the Internet Memorial Service ([Link]) for the abortus
only needs to provide his/her email address. FEHD will then create a dedicated memorial webpage displaying the name
of abortus (if name of abortus is not available at the time of application, the name of abortus would be set as the abortus of
the name of the mother concerned, i.e. abortus of XXX) and date of abortion. A notification email for confirmation will
be issued within two working days after the keeping service of abortus starts. The applicant may then activate the
account, log in to the webpage and edit the contents at any time. The Internet Memorial Service is free of charge.
5. 此申請表格的己部須由申請人親自簽署，否則本申請將被視作無效。申請人如無簽名的能力，則須在高級衞生督
察（墳場及火葬場）、衞生督察（墳場及火葬場）或高級管工（墳場及火葬場）面前畫上記號。
Section F of this application form must be signed by the applicant personally. Otherwise, this application will be treated
as null and void. If the applicant is unable to sign the application, he/she is required to attend either before the Senior
Health Inspector (Cemeteries and Crematoria), Health Inspector (Cemeteries and Crematoria) or Senior Foreman
(Cemeteries and Crematoria) to make his/her mark.
6. 放置流產胎的容器必須以紙或卡紙製造，申請人須自行準備及提供。容器之長度、闊度及高度分別不得多於 360
毫米、240 毫米及 180 毫米。若容器的要求不符合上述任何一項的規定，食環署將會取消相關流產胎安放服務的批
核。
The container for keeping the abortus must be made by paper or cardboard, the applicant must prepare and supply the own
container. The length, width and height of the container shall not exceed 360 mm, 240 mm and 180 mm
respectively. If any of the requirements of the container is not complied with, FEHD will revoke the approval for the
keeping service of abortus given.
7. 申請人須帶備的文件：
The applicant should produce the following documents:
i. 由本地醫生或醫院或註冊醫療機構簽發的「流產胎文件」或其他證明文件正本及副本一份；
the original and copy of the “Documentation on Abortus” or other documentary proof issued by local medical
practitioner or hospital or registered healthcare facility;
ii. 申請人的香港身分證正本及副本一份；以及
the original and a copy of his or her own HKID Card; and
iii. 流產胎母親的香港身分證副本一份（只適用於申請人並非流產胎母親）。
a copy of the HKID Card of the abortus’s mother (only applicable when the applicant is not the mother of
abortus).
申請人可將已填妥的申請表格，連同上述文件的副本於辦公時間內親自交到下列的食環署墳場及火葬場辦事處。
如以郵遞／傳真／電子表格／電郵 (cc@[Link]) 等方式遞交申請，只須提交上述文件副本。在安放當日，申
請人必須帶同上述文件正本交予食環署職員核對，否則食環署可就申請人已提交的文件副本轉交簽發醫生或醫院
或註冊醫療機構核實其真確性。食環署在得到文件核實結果前，保留拒絕提供服務的權利。
The applicant can submit in person the completed application form, together with copies of the above documents, to the
Cemeteries and Crematoria Offices stated below during the office hours. The applicant may also submit the completed
application form with the copies of required documents by fax / post / eform / email (cc@[Link]). The original
copies of the above documents must be submitted on the date of deposition for verification. If failure to provide,
FEHD may forward the copies of submitted documents to local medical practitioner or hospital or registered healthcare
facility for verification. FEHD reserves the rights of not providing the service before the receipt of the result of document
verification.
FEHB 282 (11/2023) 3
8. 一般情況下，食環署可於收到已填妥申請表格及所需證明文件日期起計五個工作天內批核。
In general, approval will be granted by FEHD within 5 working days from the date of receipt of a duly completed
application form and required supporting document(s).
9. 為衞生地處理流產胎，申請人有責任安排領取流產胎及安放於同日進行。
For hygienic handling of abortus, the applicant has the responsibility to arrange retrieval and keeping of abortus to be
conducted on the same day.
10. 須遵守的要求或條件如下：
Requirements or Conditions to be complied with are as follows:
(i) 在申請獲得批准後，申請人應聯絡有關醫院／醫療機構，自行安排在已批准的安放日期當日從持有流產胎當
局／人士領取流產胎並隨即帶到食環署安放設施進行安放。
Upon approval of the application, the applicant shall liaise with the hospital/healthcare facility concerned and shall
arrange the retrieval of the abortus from the authority in possession of the abortus and thereafter bring the abortus to
the keeping facility of FEHD on the approval day of deposition on his/her own.
(ii) 申請人明白及同意，為處理此申請或確保交回的流產胎如期地以妥善的方式處理，食環署及正或曾持有流產
胎當局／人士在其認為適當的情況下，可向第三者披露申請人及其流產胎的姓名及其他有關此申請或流產胎
的資料。
The applicant understands and agrees that FEHD and the authority/person in possession of the abortus currently or
previously may disclose his/her name and the name of the abortus and other information to a third party whenever
they consider it appropriate for the purpose of processing the application and ensuring the handling of the released
abortus in an appropriate manner as scheduled.
(iii) 申請人須自行聘請其服務提供者挖掘所編配的流產胎安放位置（深度為 500 毫米） ，並於安放流產胎後以泥土
填滿安放位置至地面。
The applicant shall hire his/her own service provider for digging the assigned keeping space for abortus (with a depth
of 500 mm) and refilling the keeping space by soil up to the ground level after placing the abortus therein.
(iv) 申請人須自行準備安放流產胎的容器，該容器必須以紙或卡紙製造，它的長度、闊度及高度不得多於 360 毫
米、240 毫米及 180 毫米。申請人不可在容器內或在獲編配的安放位置內放置任何非自然分解的物品。若容
器的要求不符合上述任何一項的規定，食環署將會取消相關流產胎安放服務的批核。
The applicant shall prepare the container for keeping the abortus, which must be made by paper or cardboard. The
length, width and height of the container for keeping the abortus shall not exceed 360 mm, 240 mm and
180 mm respectively. Placing of any non-biodegradable objects inside the container or the assigned keeping space
is not allowed. If any of the above requirements of the container is not complied with, FEHD will revoke the
approval for keeping service of abortus.
(v) 在任何情況下，申請人均不可領回已安放於安放設施內的流產胎（連同容器及其他物品）。
Under all circumstances, abortus (together with container and other items) kept in the keeping facility is not
retrievable.
(vi) 食環署在流產胎回歸自然後可重用相關安放位置，並無須向申請人作另行通知。
FEHD may re-use the keeping space concerned after the abortus is returned to nature without further notice to the
applicant.
(vii) 流產胎安放位置均由食環署所編配。不可在安放位置上置放標記、紀念碑像、石碑或裝飾物。但申請人可在
設施內的指定位置安裝紀念牌匾並須遵辦相關條件。
The keeping space for abortus is assigned by FEHD. Neither marking, monument, commemorative tablet nor
ornament is allowed on the keeping space. However, the applicant could choose to mount a commemorative plaque
at a specified place within the keeping facility, and is required to comply with the relevant conditions.
(viii) 若申請人未能在批核日期起計三個月內將流產胎安放於安放位置內，有關批准將會被「視作無效」 ，食環署也
不會另行通知。
If the applicant fails to place the abortus at the keeping space within 3 months from the date of approval, the
approval will be regarded as “Invalid” without further notice.
(ix) 申請表格內所填報的流產胎姓名（如有）及其母親姓名必須與有關的證明文件相符。
The name of abortus (if any) and the mother’s name on the application form should be identical to that stated in the
documentary proof.

FEHB 282 (11/2023) 4

11. 一般查詢
General enquiries
港島墳場及火葬場辦事處 － 香港跑馬地黃泥涌道 1 號 J（香港墳場側） 電話號碼：2570 4318
Hong Kong Cemeteries and 1J Wong Nai Chung Road, Happy Valley, Tel. No.
Crematoria Office Hong Kong (Next to Hong Kong Cemetery) 傳真號碼：2591 1879
Fax No.
九龍墳場及火葬場辦事處 － 九龍紅磡暢行道 6 號地下高層 電話號碼：2365 5321
Kowloon Cemeteries and Upper Ground Floor, Tel. No.
Crematoria Office 6 Cheong Hang Road, Hung Hom, Kowloon 傳真號碼：2176 4963
Fax No.
12. 收集個人資料聲明 Personal Information Collection Statement
(i) 食環署會利用經本表格所提供的個人資料，處理流產胎安放服務的申請事宜。提供個人資料與否，純屬自願
性質，但在資料不足的情況下，食環署有可能沒法處理有關申請。
The personal data provided by means of this form will be used by FEHD for purposes relating to applications for the
keeping service of abortus. The provision of personal data by means of this form is voluntary. However, if the
applicant does not provide sufficient information, we may not be able to process the application.
(ii) 本表格內所提供的個人資料，可能會被轉交其他政府部門或機構，以達致上文第 12(i) 段所載的目的。
The personal data provided by means of this form may be disclosed to other government departments and agencies in
pursuance of the purposes mentioned in paragraph 12(i) above.
(iii) 根據《個人資料（私隱）條例》第 18 條、第 22 條及附表 1 內第 6 原則的規定，申請人有權查閱及更正他／
她提供的個人資料。查閱的權利包括有權索取本表格內所提供的個人資料副本一份。食環署應查閱要求而提
供資料時，可能會徵收費用。
The applicant has a right of access and correction with respect to the personal data provided for in accordance with
Sections 18 and 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance. His/her right of access
includes the right to obtain a copy of his/her personal data which he/she has provided by means of this form. A fee
may be imposed for complying with a data access request.
(iv) 如對經由本表格提供個人資料一事有任何疑問，包括查閱及更正個人資料等，可向食環署高級衞生督察（墳
場及火葬場）提出，聯絡資料已在上面列出。
Enquiries concerning the personal data collected by means of this form, including access to and correction of the
data, should be addressed to the Senior Health Inspector (Cemeteries and Crematoria) of FEHD, the contact
particulars are listed in the above.

安裝紀念牌匾須遵辦的條件 Conditions for Mounting Commemorative Plaques

1. 安放設施內的紀念匾位是供紀念有關流產胎之用，由食環署編配。
The commemorative plaque space in the keeping facility is for the purpose of commemorating the abortus being kept in the
facility and is allocated by FEHD.
2. 申請人須聘請食環署的登記承辦商負責安裝紀念牌匾。
The applicant shall engage a registered contractor of FEHD for the mounting of commemorative plaque.
3. 紀念牌匾必須由已向食環署登記的承造商及在食環署人員監督下安裝，並須符合下列條件：
The memorial plaque, which should be mounted by a contractor registered by FEHD and under the supervision of FEHD
staff, is subject to the following conditions:
(i) 紀念牌匾必須是用一種名為「他拉維天奴」的意大利雲石（俗稱［有窿石］ ）或相同色調的雲石製造，而牌匾
的長度及闊度分別約 150 毫米及 55 毫米。紀念牌匾的右下角，需要刻上食環署為每個紀念匾位所訂的編號
（例：A028） ，而每個字體的面積須符合場地管理的規定。
The commemorative plaque shall be “Travertino” marble or a marble of the same colour tone, and its length and
width shall be about 150 mm and 55 mm respectively. The serial number (e.g. A028) assigned by FEHD for each
plaque space is required to be etched into the lower right corner of the plaque according to the requirements of the
venue. The font size of each letter/digit shall be determined by the venue management.
(ii) 除獲得食物環境衞生署署長的批准外，紀念牌匾上嵌鑲相片區域及銘文以外的區域須保持「他拉維天奴」雲
石原色，匾面的任何部分均不可嵌鑲外物。
Except with the permission from the Director of Food and Environmental Hygiene, the rest of the commemorative
plaque shall maintain the original color tone of “Travertino” marble other than the areas for photo and inscription.
No part of the commemorative plaque shall be inlaid with foreign objects.
4. 申請人在安裝紀念牌匾前，必須將牌匾上銘刻（包括文字及圖案）的紙樣，交予食環署作記錄之用；如牌匾上所
載的流產胎姓名與申請表格內的姓名不相符，申請人須作出特別申報。
Prior to the mounting of the commemorative plaque, the applicant shall submit to FEHD the inscription of the plaque
(including text and pattern) on paper for record purpose. In case the name of the abortus shown on the plaque does not
tally with that in the application form, the applicant shall make a special declaration.

FEHB 282 (11/2023) 5

5. 安裝紀念牌匾的工程完成後，申請人如要作出改裝或更改其銘刻（包括文字及圖案） ，須另行申請，在獲食環署批
准後才可進行。
In case the applicant wishes to make an alteration or a change in the inscription (including text and pattern) after the
mounting works of the commemorative plaque are completed, an application shall be made for that purpose and the
approval by FEHD shall be obtained prior to such alteration and change.
6. 請注意，食環署可移走任何未經准許而放置在流產胎安放位置及紀念匾位的紀念碑像、石碑、銘文、插花盛器，
裝飾物等物品，而不事前通知。
Please pay attention that FEHD may remove without prior notice any monument, commemorative tablet, inscription,
receptacle for flowers, ornament, etc. which are placed in any keeping spaces and plaque wall spaces without prior
permission.

FEHB 282 (11/2023) 6