1969-HKRS30-8-59_Part03 — Page 40

Location:

地

點

M

Trade Name and Nature of Business :

名及性

Structure(s) permitted on site,

獲准注胲醭上無有忿榮物

:

Length.

矮

2.

3.

Width.

3

Site No. and Size:

2.

Photographs required---- 二、附貼片台

Lise.

用途

Height.

1. 2.

3.

Amount of quarterly fee and date of

commencement of occupation.

拇練想赭讚讚數額萬關帕佔用日期

Month. Day.

Each Year.

ዞ

Payabic at 47

Resettlement Estate/Cottage Area Office on

1.

2.

3.

新區,平區辦事處按照有關日期:

4.

Name of licensee.

Age, Sex 年藏

LC No.

性別

身份證號數

Name(s) of authorized operator(s).

Caretaker and family living on site.

Name.

Sex

姓名

年歲

性别

IC NO 身份蹤號歛

Relationship. 與管理人之關供

1.

2.

3.

4.

3.

Total No. of Persons:

譏人數:

M 男

(c) photograph of licensees.

[甲持燃片

(5)

(c)

photograph of operator where the operator is not the licensee ............

photograph of caretaker and his family living on the site where the caretaker is neither the licensed nor the operalOT

3.

T

This licence is not transferable.

本想不得鹼蹼

I, the undersigned licenses, fully understand and agree that this licence is subject to the conditions set oul herein and to any conditions which

may be imposed by the Competent Authority from time to time.

本持躞人-

分明瞭並同意本親爆受證內所載各項規條及主管當局所翻時釐訂之 任何覘錄所限制。

F.

C.

小直

Date

日期

Licensee.

持證人

Competent Authority.

主管當局