CO537-4801 — Page 31

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THE HONG KONG GOVERNMENT GAZETTE.

Identity Card No:

Form 2 (a).

(Rule 7)

Registration of Persons Rules, 1949.

Form 2 (APPLICATION FORM).

Pursuant to the provisions of the Registration of Persons Ordinance,1949, 1, the undersigned, do hereby certify that the following is a true record of the particulars in respect of myself as on the (a)........ and that in the attached (b)....... sheets is recorded the information

truly given by me in respect of members of my family of the age of twelve

years and upwards.

余本人卽署名於後之人茲依照一九四九年人口登記則例之規定証明下開所錄關於余本 人之各事項以(a)......

算均屬眞確無訛並証明在所附表格(b)... ........ IZNE

註明余家內人口足十二歲以上者所報告於余之各項眞確詳情

(1) (a) Applicant's Reference No.

申請人自己之編號

Signature of Applicant.

申請人署名

Date:

日期

Signature of Registration Officer.

登記員署名

(1)(b) Subsidiary Serial No. for members of family of the age of twelve years and upwards: 僱員家屬足十二歲以上者之分編號數

(2) Name (in English):

英文姓名

(3) Name (in Chinese characters):

中文姓名

(4) Address (in English):

英文住址

(5) Address (in Chinese characters) :

中文址

(6) Age last birthday:

是若干歲

(8) Race (if Chinese write "C" or if

of other race write in full):

種族(倘係中國人可寫英文字母“C”字 其餘則寫明屬何種族)

(9) Nationality (if Chinese write "C" or if of other nationality write in

full):

國籍(倘係中國籍可寫英文字母“C”字 僑係別國國籍者則寫明是何國籍)

(10) Occupation:

(7) Sex (M. or F.)

性别

職 業