4
Hong Kong Identity Card No.
19......... has been registered in accordance with
Fee:
• Delete whichever is not applicable.
Address:
地址
-
Note: This notice must be given to the same designated public officer to whom the notice under section 16(1) of the Ordinance was given. 附註:本通知帶必須送交能此根據該賺例第十六款第(一)段規定之通知書所發
交之指定主管人員。
FORM 10.
MARRIAGE REFORM ORDINANCE.
SECTION 17(2),
第十七款第(二)段
Statement of Designated Public Officer. 由指定主管人目颟耠之聲明竈
(WARNING: This is nor a Certificate of Dissolution of a Marriage). [注意:本聲明書並非解除婚姻褪仴言,
No.
號
Do the
day of
九
年
具
(husband) and
of 19. 年份:一九
19.........
(wife),
(養室)、
who are parties to a "customary/validated marriage, gave me notice in
accordance with section 1601) of the Marriage Reform Ordinance of their 为,就依照襲釘彜嫻菜阕第十六款第 intention to dissolve their marriage in accordance with Part V of the C
Ordinance. The marriage, which took place on the
怨
月 日舉行 兼日佬爾嫌例第四 Part IV of the Ordinance and was subsisting on the appointed day 塵之規定而册,且在指定日期时 九七 年 (7.10.1971). *Both the parties have (One of the parties, namely
-
打 即
口
....... has] a substantial connexion with Hong Kong.
2. I. baving interviewed the abovementioned parties in accordance
with sections 17 and 18 of the Ordinance, hereby state that I am satisfied 之規定接見上述明女方
that.
(a) the notice of intention to dissolve the marriage was given to me
by the abovementioned parties under section 16(1) of the Ordin-
ance and that no notice of changed intention under section 16(2)
was given; and
知逕
(6) the parties understand that the effect of dissolution is to put an
end to the marriage so as to permit them la marry again should
以便在何
曾
gither of them so wish; and
裈婚: K
腻
(c) the parties freely and voluntarily desire to dissolve the marriage.
(丙)雙方均糠自願自勵將婚跺者
Dated this
日期:
Fee: $50.
費用: 五十元
day of
丸
19.........
Designated Public Officer. 相戀主管人員濉器
*Headquarters, Secretariat for Home Affairs/
Headquarters, New Territories Administration?
District Office.
day of
• Delete whichever is not applicable.
理