TNAG-1554-FCO40-2118-Hong-Kong-Control-of-Publications-Consolidation-Ordinance-19-1986 — Page 13

(*Note: insert "No change" where furnished particulars

remain unchanged.

1.

I certify that the above particulars and my

description are correct.

2.

Fee: $

enclosed.

Signature of informant:

Description

of informant:

Date:

(proprietor or otherwise)

Note: This form must be completed in duplicate.