Hong Kong identity card no. of printer

Full name of publisher of bulletins (if different from

printer)

Business address of publisher

Tel.:

Residential address of publisher

Tel.:

Hong Kong identity card no. of publisher

Full name of editor of bulletins

Business address of editor

Residential address of editor

Tel.:

Tel.:

Hong Kong identity card no. of editor

1.

I certify that the above particulars and my

description are correct.

2.

Fee: $

enclosed.

Signature of informant:

Description

of informant:

Date:

(proprietor or otherwise)

Note: This form must be completed in duplicate.

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