1964_PAWNBROKERS_REGULATIONS — Page 12

A 12

[Subsidiary]

CAP. 166]

Pawnbrokers Regulations

[1984 Ed.

1. That I am the borrower and/or* the owner of goods pawned in respect of the

following loan made with you-

Date of

advancing

money on loan

Description of goods

Rate of interest

Amount of loan

Duration of loan

2.

I no longer have the ticket relating to the loan in my possession for the following

reasons-

(give details)

And I make this solemn declaration conscientiously believing the same to be true.

Declared at day of....

*(delete as required)

Signed

in Hong Kong this

19........

Before me

Pawnbroker.

Directions to pawnbroker

In taking this declaration you should ask the person so declaring to confirm that

he is the person named and described in the declaration, that the contents of the

declaration are true and that the signature is his signature.

表格五

【規例第六條】

當押業條例(第十四條)

(香港法例第一六六章)

當押業規例

遺失當票宣誓書

致:(當押業商名稱)

本人(宣誓人姓名、身份證明文件類別及號碼)

居於(地址)

現