2
1. 本人謹作以下聲明:
(i) 本人為上述申請兒童的家長 / 監護人*；及
(ii)
此表格內的資料全屬正確無訛。
申請兒童獲派的學位將會被取消。
2.
本人明白教育局會在有需要時採取適當的行動，查核此申請表內所提供的
資料，及/
或有關此申請所提供的資料的真確性。教育局亦可能因此而要求
本人面見並提供任何相關的文件和資料，及/
需要，教育局亦可能會進行家訪，查核此申請表內所提供的，及/
請有關的資料的真確性。本人亦
作出上述要求，以證實此申請表內，及/
性和真確性，而本人又未有向教育局提供此等協助及/
就本人的申請採取相應行動，其中包括暫緩處理有關的申請。
3.
本人同意教育局聯絡有關人士、公司、機構或政府部門，向他們透露在此
申請表內，及/或與此申請有關的個人資料，以核實此申請表內，及/或與此
申請有關的資料的真確性及作學位分配事宜和其他與教育有關的用途，本
人亦同意任何人士、公司、機構或政府部門為此向教育局透露本
資料。
4. 本人已明白印於本頁下半部份
關查閱及改正資料的權利。
5.
本人確知只能為申請兒童向
一間官立或資助小學申請學校自行分配的學
位。倘若同時申請多間官立或資助小學，則本申請將會作廢及申請兒童將
不獲分派自行分配學位。
6. 本人已明白申請兒童如獲直接資助計劃 (直資)
校小一學位後，將不能透過小一入學統籌辦法獲派小一學位。如他/她已透
過小一入學統籌辦法獲派學位，該學位亦會被取消。
7.
本人已明白申請兒童若已獲私立小學取錄而
法，其名字將會在統一派位結果公布前送交有關小學參考。
*請將不適用者刪去
(i) I am the parent/guardian* of the aforementioned applicant child; and
(ii) To the best of my knowledge and belief, the information contained in this form is true
and correct. If false information is provided, this application will be rendered null and
void and the Primary 1 place allocated on the basis of this application will be
withdrawn.
2.
I understand that the Education Bureau (EDB) will take measures as they consider necessary
and appropriate to verify the information provided in and/or in relation to this application
and I may be required to attend interview and provide EDB with any document and
information, and/or to make any sworn declaration for such purpose. I understand that EDB
may also conduct home visits to verify the information provided in and/or in relation to this
application as and when necessary. I understand that if EDB is not provided with such
assistance and/or information as reasonably necessary to satisfy it as to the accuracy and
truthfulness of the information provided in and/or in relation to this application, EDB will
take any necessary action in relation to my application, including holding it in abeyance.
3. I give consent to EDB to disclose the personal data provided in and/or in relation to this
application to, and to liaise with, any person, company, organis
ation or government
department/bureau concerned for the purpose of verifying the information provided in
and/or in relation to this application, school places allocation and other education-
purposes. I also give consent to any person, company, organis
department/bureau to release my personal data to EDB for any of such purposes.
4. I understand the purposes for which the personal data provided by means of this form will
be used, as well as my rights for data access/correction as printed below on this page.
5. I understand that I may apply for a discretionary place for the applicant child in only ONE
government or aided primary school. I also understand that if multiple applications are
made, this application will be rendered null and void and any discretionary place offered on
the basis of this application will be withdrawn.
6. I understand that if the
aforementioned applicant child has accepted the offer of a Primary 1
place in a Direct Subsidy Scheme primary school, he/she will not be allocated a Primary 1
place through the Primary One Admission System. If a school place has been allocated to
him/her through the Primary One Admission System, that school place will be withdrawn.
7.
I understand that if the aforementioned applicant child has been offered a Primary 1 place
by a private primary school and yet opted to remain in the Primary One Admission System,
his/her name will be sent to the primary school concerned for information prior to the release
of results of Central Allocation.
* Delete whichever is inappropriate
日期
Date:__________________________________________
家長或監護人簽署
Signature of parent/guardian:______________________________________
Notice to P
arents
(1) 你在此表格所提供的個人資料，
將用於核實此申請表內，及/或與此申請有關的資料的真確性或作學位分配事宜及其他與教育有關的用途。獲得「自
行分配學位」的申請兒童姓名將在有關的學校張貼。
The personal data provided by means of this form will be used for verifying the information provided in and/or in relation to this application, school places
allocation and other education-related purposes. Names of successful applicant children for the discretionary places admission will be posted up at the schools
concerned.
(2) 本局可能將收集所得的個人資料向任何有關人士、公司、機構或政府部門及你的子女獲派/轉讀的學校披露，以作任何上述第(1)段所述的用途。
The personal data collected may also be disclosed to any person, company, organization or government department/bureau and the school to which your child
is allocated/transferred for any of the purposes mentioned in paragraph (1) above.
(3) 你必須在此表格提供所需的個人資料。倘若所提供的資料不充足，教育局可能無法辦理有關申請。
The provision of the personal data by means of this form is obligatory. If you do not provide sufficient information, the Education Bureau may not be able to
process your application.
(4) 根據《個人資料（私隱）條例》第 18 和 22 條及附表 1 第 6 原則的規定，你有權更改或查詢所提供的個人資料。
You have the right of access and correction with respect to the personal data as provided for in Sections 18 and 22 and Principle 6 of Schedule 1 of the Personal
Data (Privacy) Ordinanc
e.
(5) 任何與所收集的個人資料有關的查詢，包括要求查閱和改正資料，應提交：
Enquiri
es concerning the personal data collected, including the making of access and corrections, should be addressed to:
九龍觀塘
偉業街 223 號
宏利金融中心 2 樓 2 室
教育局學位分配組
高級教育主任
Senior Education Officer,
School Places Allocation Section, Education Bureau
Office 2, 2/F,
Manulife Financial Centre,
223 Wai Yip Street,
Kwun Tong,
(6) 根據刑事條例（香港法例第 200 章
），任何人製造虛假文書，意圖由其本人或他人藉使用該文書而誘使另一人接受該文書為真文書，並因接受該文
書為真文書而作出或不作某些作為，以致對該另一人不利，則該名首述的人即犯偽造的罪行，一經循公訴程序定罪，可處監禁 14 年。
A person who makes a false instrument, with the intention that he/she or another shall use it to induce somebody to accept it as genuine, and by reason of so
accepting it to do or not to do some act to his/her own or any other person’s prejudice, commits the offence of forgery and is liable on conviction on indictment
to imprisonment for 14 years under the Crimes Ordinance, Cap. 200 Laws of Hong Kong.
(7) 有關小一入學一般查詢，可致電 2832 7700 與教育局學位分配組聯絡。
For enquiries concerning Primary One Admission, please contact the School Places Allocation Section of the Education Bureau at 2832 7700.
注意：如需列印/影印此申請表使用，必須將第一及第二頁作雙面列印/影印
Note: If you would have to use printed/photocopied application form, please ensure P.1 and P.2 are printed/photocopied on the same sheet (i.e. double-sided printing).
POA113 (Rev. 7/21) Downloadable version
