A6
[Subsidiary]
CAP.326]
Drug Addicts Treatment and Rehabilitation Regulations
[1972 Ed.
Dated this day of 19.........
日期: 一九 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 3
表格三
[r. 3.]
(規則第三款)
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)
Bond to pay Cost of Treatment
繳付治療費保證書
BY THIS BOND I
本人
(Name in English).
(英文姓名)
..) of
(Name in Chinese Characters, if any).
(Address).
(......... .) 現居
(中文姓名)
(地址)
acknowledge myself bound to
茲根據上述條例第十一款之規定,以本保證書向*
in accordance with the provisions of section 11 of the Drug Addicts Treatment
and Rehabilitation Ordinance, in the sum of $..
(........
(港幣
保證,繳交$
Hong Kong Dollars)
元)
to be paid to the said
*
Sealed with my seal this day of... 19
本保證書由本人於一九 年 月 日蓋印。
NOW THE ABOVE WRITTEN BOND is conditioned to be void in
上述
case the above-bounden
保證人
his , 其
personal representative or any person acting for or on behalf of him shall
代表人由接獲合法之繳款通知起 within one month of the lawful demand therefor, from time to time, pay
個月內將所有應繳款項交與*