1964_DRUG_ADDICTS_TREATMENT_AND_REHABILITATION_REGULATIONS — Page 4

A4

[Subsidiary]

CAP.326]

Dated this

日期:

-

九

Signed by the said

本申請書由該

Drug Addicts Treatment and

Rehabilitation Regulations

[1972 Ed.

day of......

年

19.........

月

日

in the presence of

在

面前簽署。

(Signature of Applicant).

(申請人簽署)

The Hong Kong Government or such other person as may be entitled thereto.

* 請填香港政府或有權收費之其他人士。

FORM 2

表格二

[r.2.]

(規則第二款)

Drug Addicts Treatment and REHABILITATION ORDINANCE 戒毒人治療與康復榮例

(Chapter 326)

(香港法例第三二六章)

Application for Admission to an Addiction Treatment Centre 入戒毒所申請書

The Superintendent of

the Addiction Treatment Centre at

Hong Kong.

(Name in Chinese Characters, if any).

香港

戒毒所所長鑾

I

(........

(Name in English).

本人

(英文姓名)

of

(Address).

現居

(地址)

J

(中文姓名)

hereby apply, în

茲根據

accordance with the provisions of section 7 of the Drug Addicts Treatment and 戒毒人治療與康復條例第七款之規定申請 Rehabilitation Ordinance, for the admission of

將

(.......

......) of

(Name in Chinese Characters, if any).

其地址為

(中文姓名)

(Name in English).

(英文姓名)

(Address).

(地址)

a young person, of whom I am a parent/the guardian, to the above-mentioned ,收容於上述戒毒所內。其入保一青年,而本人則爲其

Addiction Treatment Centre.

家長/監護人口