A4
[Subsidiary]
CAP.326]
Dated this
日期:
九 年 月 日
Signed by the said
本申請書由該
in the presence of
在 面前簽署。
(Signature of Applicant).
(申請人簽署)
The Hong Kong Government or such other person as may be entitled thereto.
* 請填香港政府或有權收費之其他人士。
FORM 2
表格二
[r.2.]
(規則第二款)
Drug Addicts Treatment and REHABILITATION ORDINANCE
戒毒人治療與康復條例
(Chapter 326)
(香港法例第三二六章)
Application for Admission to an Addiction Treatment Centre
入戒毒所申請書
The Superintendent of
the Addiction Treatment Centre at
Hong Kong.
I
(Name in English).
(英文姓名)
(Name in Chinese Characters, if any).
(中文姓名)
of
(Address).
現居
(地址)
hereby apply, in accordance with the provisions of section 7 of the Drug Addicts Treatment and Rehabilitation Ordinance, for the admission of
茲根據戒毒人治療與康復條例第七款之規定申請
(Name in English).
(英文姓名)
(Name in Chinese Characters, if any).
(中文姓名)
of
(Address).
其地址為
(地址)
a young person, of whom I am a parent/the guardian, to the above-mentioned Addiction Treatment Centre.
將 其 收容於上述戒毒所內。其入保一青年,而本人則爲其家長/監護人。