(
乙
)
欄—— 聲明書
PART B——Declaration
本人謹此聲明：
I declare that :
(1) 背頁所述的兒童為本人的
親生╱ 領養╱ 繼子╱女或 受本人監護的。本人將負責將他╱她的永久性居民身份證妥為保存。
The child mentioned overleaf is my
natural/ adopted/ step son/daughter or ward and that I shall be responsible for the safe custody of that child
’
s Hong
Kong Permanent Identity Card.
(2) 該兒童
曾╱ 並無因定居外國而取得外國國籍。
The child
has / has not acquired foreign nationality through settlement overseas.
(3) 該兒童是中國公民並有香港居留權及從未向入境事務處作出變更國籍的聲明。
The child is a Chinese citizen having the right of abode in Hong Kong and no declaration of change of nationality has been made to the Immigration Department in
respect of him/her.
(4)
(i) 該兒童是在香港特別行政區成立以前或以後在香港出生。
The child was born in Hong Kong before or after the establishment of the Hong Kong Special Administrative Region.
(ii) 該兒童已在香港特別行政區成立以前或以後在香港通常居住連續七年以上。
The child has at any time ordinarily resided in Hong Kong for a continuous period of not less than seven years before or after the establishment of the Hong Kong
Special Administrative Region.
(iii) 該兒童是在香港特別行政區成立以前或以後在香港以外地區出生，而在出生時該兒童的 父親 ╱ 母親是中國公民並附合 在香港出生╱ 在香港已通
常居住連續七年以上的條件，享有香港居留權。
The child was born outside Hong Kong before or after the establishment of the Hong Kong Special Administrative Region and the child
’
s
father/ mother is a
Chinese citizen who, at the time of birth of the child, has the right of abode in Hong Kong by birth in Hong Kong/ by ordinarily resident in Hong Kong for
a continuous period of not less than seven years.
(5) 就本人所知及所信，此申請書所填報的資料均屬真實無誤。
The information given in this application is true to the best of my knowledge and belief.
(6) 本人對該兒童的監護權並未受任何法院頒令所限制。
My rights in respect of the child have not been limited in any way by the order of any court.
父、母或合法監護人簽署 日期
Signature of parent or legal guardian
__________________________________________________
Date
_____________________________________________
父、母或合法監護人全名
Full name of parent or legal guardian
__________________________________________________
請在適當方格內填上「
✓
」號 Please tick
“
✓
”
in the appropriate box
(
丙
)
欄——以下由中國駐外國的使、領館填寫
PART C——For use of Chinese Embassy/Consulate-General
(1) 這是首次的永久性居民身份證申請，無須繳費。
This is the first application for a Permanent Identity Card. No fee is required.
(2) 這是因遺失╱損壞智能身份證而補領永久性居民身份證的申請。
申請費用港幣 ____________ ╱美元 ____________ * 已包括在香港特區護照申請費用的支票或銀行匯票之內，號碼： ____________ ╱由香港諮詢人付款。
申請費用港幣 ____________ ╱美元 ____________ 支票或銀行匯票號碼： ____________ * 包括銀行手續費港幣 ____________ ╱美元 ____________ （若支票或銀
行匯票並非指明由香港特別行政區的銀行付款或非以香港特別行政區貨幣開出）已收訖。
This is an application for the replacement of a Permanent Identity Card due to loss/damage of a Smart Identity Card.
An application fee of HK$ ____________ /US$ ____________ *has been included in the cheque or bank draft no. ____________ for Hong Kong Special Administrative
Region passport application fee/will be paid by referee in Hong Kong.
A cheque or bank draft no. _____________ for a fee of HK$ _____________ / US$ _____________ *including bank handling charge of HK$ _____________ /
US$ ____________ (if the cheque or bank draft is not drawn on a bank in the HKSAR or not in HKSAR currency) has been collected.
(3) 這是因需要改動智能身份證內容而要求更換永久性居民身份證的申請。
申請費用港幣 ____________ ╱美元 ____________ * 已包括在香港特區護照申請費用的支票或銀行匯票之內，號碼： ____________ ╱由香港諮詢人付款。
申請費用港幣 ____________ ╱美元 ____________ 支票或銀行匯票號碼： ____________ * 包括銀行手續費港幣 ____________ ╱美元 ____________ （若支票或銀
行匯票並非指明由香港特別行政區的銀行付款或非以香港特別行政區貨幣開出）已收訖。
This is an application for the replacement of a Permanent Identity Card due to alteration of particulars on a Smart Identity Card.
An application fee of HK$ ____________ /US$ ____________ *has been included in the cheque or bank draft no. ____________ for Hong Kong Special Administrative
Region passport application fee/will be paid by referee in Hong Kong.
A cheque or bank draft no. ____________ for a fee of HK$ ____________ /US$ ____________ *including bank handling charge of HK$ ____________ /
US$ ____________ (if the cheque or bank draft is not drawn on a bank in the HKSAR or not in HKSAR currency) has been collected.
(4) 香港特別行政區護照的申請已查核無誤。
The application for a Hong Kong Special Administrative Region passport has been checked and found to be in order.
(5) 永久性居民身份證的申請已查核無誤。
The application for a Permanent Identity Card has been checked and found to be in order.
(6) 備註﹙如有﹚
Remarks (if any)
簽署
Signature
日期
Date
請在適當方格填上「
✓
」號 Please tick
“
✓
”
in the appropriate box
* 請將不適用者刪去 * Please delete as appropriate
ROP 144 (12/2017)
