REGISTRATION AND ELECTORAL OFFICE

APPLICATION BY AN INDIVIDUAL FOR REGISTRATION IN A FUNCTIONAL CONSTITUENCY AND AN ELECTION COMMITTEE SUBSECTORREPORT ON CHANGE OF PARTICULARS

(REO-GN1)

IMPORTANT : Please read the relevant guidance notes (REO-GN1) before completing this form in BLOCK LETTERS. You should provide clear and accurate information for voter registration. Unclear or inaccurate information may lead to unsuccessful voter registration. A person who knowingly or recklessly makes any false or incorrect statement or gives information which is materially false or misleading commits an offence under the law.

1. HK IDENTITY CARD NUMBER

Prefix Number Check Digit 2. SEX

Male Female ( )

3. MY NAME AS SHOWN ON THE HK IDENTITY CARD

Name in Chinese

in Chinese Commercial Code

Surname

Other Names in Full

4. MY RESIDENTIAL ADDRESS IN HONG KONG. Please complete in CHINESE or in ENGLISH Block Letters.

/ Flat/Room

() Floor

Block

Name of Building

/ Name of Estate / Number and Name of Village

/ Number and Name of Street / Lot Number

Area and District Name

Home Telephone Number Mobile Phone Number

Office Telephone Number Fax Number

E-mail Address

( The provision of e-mail address is voluntary. The e-mail address will be provided to the candidates of the constituencies/subsector concerned for the purpose of sending election advertisement. The candidates may choose to send election advertisement via email in lieu of hardcopy. )

5. FUNCTIONAL CONSTITUENCY AND ELECTION COMMITTEE SUBSECTOR APPLIED FOR

Please refer overleaf for the names of the functional constituency and Election Committee subsector and the points to note. Functional Constituency :

Election Committee Subsector :

(1) (2)(c) If you are eligible to be registered in one of the optional subsectors (see Note (2)(c)) listed overleaf and wish to apply for registration, please fill in your choice here.

(2) If you are not eligible or do not wish to be registered in one of the optional subsectors, you will be registered in the subsector corresponding to the functional constituency (except District Council (Second) Functional Constituency) you fill in above.

(3)

If you are eligible to be registered in or have been registered in a functional constituency other than the District Council (Second) Functional Constituency, and you choose to be

registered in the District Council (Second) Functional Constituency, you will not be registered in or will cease to be registered in that other functional constituency. Further, you will not be registered in or will cease to be registered in a subsector corresponding to that other functional constituency. However, if you are eligible to be registered in one of the optional subsectors, you may apply by using this form.

Eligibility for Registration :

() (In completing the eligibility for registration, please refer to the guidance notes and select the organization/category you belong to. Where applicable, please state your membership/registration/licence number beside the organization/category you belong to.)

Employer :

6. LANGUAGE PREFERENCE FOR ELECTION-RELATED COMMUNICATIONS

Please indicate your preference by putting a tick in the appropriate box :

Chinese English

REO-41(2014) P.T.O.

REO-41

For REOs use only.

REO-41(2014)

7. DECLARATION

I declare that the particulars entered in this form are true and accurate, and that

(a) the residential address entered in this form is the address of my only or principal residence in Hong Kong; and

* (b) I am already registered as an elector in a geographical constituency/I have applied to be registered as an elector in a geographical constituency/ I am eligible to be registered as an elector in a geographical constituency, and hereby apply to be so registered; and

(c) 5 I am eligible to be registered as an elector in the functional constituency and as a voter in the Election Committee subsector applied for in Section 5; and

(d) I am not subject to any disqualification from registration; and

(e) 5 I am not appointed as an authorized representative of a corporate elector in the same functional constituency applied for in Section 5; and

(f) 5 I am not appointed as an authorized representative of a corporate voter in the same Election Committee subsector applied for in Section 5.

Signature Date Day Month Year

* Please delete whichever is inappropriate. Name of the applicant

(1) 2891 1180 Note This form may be returned by post to 13/F, Kowloonbay International Trade & Exhibition Centre, 1 Trademart Drive, Kowloon Bay, Kowloon or by fax to 2891 1180. (2)

This form is for application for registration as - (a) an individual elector in ONE of the following functional constituencies and as an individual voter in its corresponding subsector ; or

Accountancy

Health Services

Medical

Architectural, Surveying and Planning

Heung Yee Kuk

Real Estate and Construction

Catering

Import and Export

Social Welfare

Commercial (Second)

Industrial (First)

Sports, Performing Arts, Culture and Publication

District Council (First)

Information Technology

Textiles and Garment

Education

Legal

Wholesale and Retail

Engineering

(b) an individual elector in District Council (Second) Functional Constituency; or

(c) an individual voter in ONE of the following optional subsectors -

Chinese Medicine

Chinese Peoples Political Consultative Conference

Hong Kong Chinese Enterprises Association (3)

An individual can be registered in only one functional constituency/Election Committee subsector. If you are an elector/a voter already registered in a functional constituency/subsector and submit an application for registration in a different functional constituency/subsector, your new application for registration (if accepted) will replace the registration of the existing functional constituency/subsector.

(4) 2891 1001 If you have not received any reply from the Registration and Electoral Office 14 days after submission of this form, you may call the Enquiry Hotline 2891 1001 to check the progress of your application.

(5)

25 10 486 The personal data and other related information provided by you by means of this form will be used by the Registration and Electoral Office for voter registration and election-related purposes. Your provision of personal data and other related information in this form is voluntary. However, if you do not provide adequate and accurate data, the Registration and Electoral Office may not be able to process your application for registration. If necessary, the Electoral Registration Officer may require a public authority to furnish your personal data for data matching when preparing a register. The information provided by you may be provided by the Registration and Electoral Office to other authorized departments/organizations/persons for the purposes of voter registration and election under relevant Ordinances and/or subsidiary legislations and purposes related thereto. For access to and/or correction of personal data and other related information you provided, please address your request to the Electoral Registration Officer in writing (Address: 10/F, Harbour Centre, 25 Harbour Road, Wan Chai, Hong Kong). Any person who uses the personal data provided in this form without the express prior consent of the data subject for any purposes other than the purposes stated above may contravene the Personal Data (Privacy) Ordinance (Cap. 486).

CORRESPONDENCE ADDRESS (Only if there is no postal service available for your residential address)

REGISTRATION AND ELECTORAL OFFICEAPPLICATION BY AN INDIVIDUAL FOR REGISTRATION IN A FUNCTIONAL CONSTITUENCYAND AN ELECTION COMMITTEE SUBSECTORREPORT ON CHANGE OF PARTICULARSREO-41 SEXFunctional Constituency :