1960-HKRS30-8-50_Part04 — Page 46

(3)

Enter the first namets) and surname as shown in the birth sectallesse related to

parnerinh 4 il mailable, otherwise enter name(s) and surname by which the Intern Wa

♪ 如点出生雏

known as the time of the application.

機

If the dafunt hus eperlopsly been adopted, à collied copy of the enter in the Adbwird

Children Register should be anached, and not a certified copy of the urlaimi katy a

the replelers of birthas and the particulari clyta in paragraph 5 abboudd metile to m

FORM 4. 馬四表格

[ruke 9.3 [规佩坡尢新⌋

Coquent to an adoption order in respect of an infant named Æ„B. (1)

Whereas an application is to be mads [by C.D./C.D. and ED]) or

Funder the serial number

.E

(4)

pacem de parama by adoption and moc to the natural parent or parents. 販蹾鸨簇就或黛母或簧空母洲非親生鷲昐口 Where

(3)

birth certificate G not attachod, mater une place (including Cullatry) of kau

If the infant jy Üllatai licorbate, the father's ohnat should not be given in this entrys bus INTE

Thla paragraph should be completed tally it use intanu bas « kogal guarding other than (甜六)如畫之合法監藻人非該旗之紀鼱海輿窳

(7)

(8)

the Duber of mother of the infant.

If the inCan f Perštimpte, enter the suurae &l ang person known to the applicar wit

haw been adjudged by an order to be bo powrive father of the infant nợ who lau

acknowledred hiswell to be the father of the infant and pgreed to contribute to Bus D

brimeraun.cs.

The names in be contraal here tor do the followinx rammarh) are thost ul the penum

named in paragrapha 2. 6 and 7. and (wbore the application le made by car of mi

bygdará sa note) of the spouse of the applicant.

悱口

This paragrant should be completed milk the nause of any of the person melentetel wel (生)

(10)

the previous note who ban was abelled his or her consent. See sabstedoen 40 sad 12

of estion d of the Adoption Ordinance, 1996, *## (-)) & (2) \ »

This rockymph need not be completed it the Appliore or elther of the replicarmen. Je li (骸)如申請人或申請人中之任何

ง

{2}

"rchauve" of the Jelani au decued by scxiom 3 of the Adoption Undiesood Pl

The paragraph meed not be completed it the Applicaer et either of the applicatti li j 九五六年纇曬子实情 "reblive" of the inlagt defined by action 2 of the Adoption Dadlanet. 潮雛

Where k la comnleted more than one referee may be named il derbres).

一人以上之名字,以懶查胸口

-

If the icant vrishen Zin ratose in be kept confidential, insem verbal mutarer mat

(缺古) 如申請人機脖陛掐架鞯秘密,則應與露根據一九五六年照

În paprance of rule 5 of the Adoption Rules, 1955,

子女雄隔斠五條規定所買得之順次號碼。

Whereas the said 4.B. (hereinafter called the infant) is not less than six 悦国装

北

弊

月 .............. og the 其年歲已不止六期,本脚現 19...................... and is the person to whom the birth certificate (9) now produced and

weeks old, having been born in

日生於

shown to be marked "A" relates]:

1, the undersigned

the mother (3) of the infant/ 黢簕熊志士(跬三)

the father of the infant/

a guardian of the infant/

being, 15

a person liable by virtue of any order or agreement to contribute to

the maintenance of the infant/

a person (acting on behalf of a body) having parental rights in respect

of the infant/

The spouse of the said C.D.

麒

hereby state as follows:

-

(1) I understand that the effect of an adoption order is to deprive a

Brent or guardian of all rights in respect of the maintenance and upbringing

of the infant.

(2) I understand that, when the application for an adoption order in

respect of the said 4.8. is beard by the judge, this document may be used

evidence of my consent to the making of the order unless I have notified the

wort that I no longer consent (6),