ATA CARNET APPLICATION FORM 暫准進口證申請表 Private …

1 PVC HANDBAGSFAX 2019/01 95 22 Hong Kong General Chamber of Commerce 22/F United Centre., 95 Queensway, Hong Kong Tel (852) 2823 1275 / 2823 1276 Fax (852) 2110 9442 Email: ATA CARNET APPLICATION FORM Private Cars Self-drive Scheme (Applicable to Hong Kong Private cars in the name of an individual) ( ) Part I Particulars of Applicant = CARNET Holder = Registered Vehicle Owner = = Name of Applicant (Name in English) ( ) Correspondence Address HKID No. Driver Tel / Mobile Email Other Contact Person/Tel / Part II Particulars of Vehicle [ ] Full Name of Owner Engine No.

2 Registration Mark Cylinder Capacity ( ) Class Colour Make Year of Manufacture Model Country of Origin Chassis No. Seating Capacity (Excluding driver) ( ) 4 OR BELOW Ad-hoc Quota and Closed Road Permit No. Part III Documents Required for Lodgement Copy of Vehicle Registration Document Copy of Hong Kong Identity Card (HKID) Copy of Ad-hoc Quota and Closed Road Permit Part IV Fees APPLICATION fee $1,000 (Optional) Import Pre-notification Service $120 ( ) Part V Guarantee Method Cash deposit to HKGCC bank account (HSBC 002-220663-008) Banker's draft (in Hong Kong dollars)

3 As a guarantee Guarantee from HK licensed bank/HK insurance company / e-Guarantee _____ _____ _____ Signature Name of Holder (in Block Letters) Date All information collected on this form is used for this APPLICATION only.