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[接上页] ............................................................................................................................................. 5. My telephone numbers are ...................... (Home) ..................... (Office). 6. I *+ have/have not been convicted in Hong Kong or elsewhere of an offence punishable with imprisonment. I *have/have not been found guilty in Hong Kong or elsewhere of unprofessional conduct. I *am/am not the subject of an existing order under section 22(1)(i) or (ii) of the Supplementary Medical Professions Ordinance. I declare that the information given in this application is correct to the best of my knowledge and belief. Signed at .................................................. } ................................................................ .................................................. the ............... day of ................. 19 .......... (Signature of Applicant) Before me, ........................................................... ............................................................. (Name in block letters) (Signature) * Radiographer registered in Part I of the Register/Barrister/Solicitor/Registered Medical Practitioner/Commissioner for Oaths. Photograph of Applicant + Please supply details of conviction. * Delete if inappropriate. (47 of 1997 s. 10) FORM 2A [section 9(1)] RADIOGRAPHERS BOARD HONG KONG SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359) Certificate of Registration Number of Register: .................. This is to certify that ...................................................................................................... whose address is ................................................................................................................... and whose photograph appears hereon was on the .............. day of ............................ 19 ........ admitted to Part .......... (Category ..........) of the Register of Radiographers. Dated this .......... day of ........................ 19 .......... Photograph ............................................. Secretary, Radiographers Board. (L.N. 90 of 2004) FORM 2B [section 9(2)] RADIOGRAPHERS BOARD HONG KONG SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359) Certificate of Provisional Registration Number of Register: ...................... This is to certify that ...................................................................................................... whose address is ............................................................................................................. and whose photograph appears hereon was on the ............. day of ................................... 19 ........ admitted to Part IV (Category ....................) of the Register of Radiographers subject to the undermentioned conditions. Conditions imposed pursuant to section 15(3) of the Supplementary Medical Professions Ordinance- Dated this .......... day of ..................... 19 ....... Photograph ............................................. Secretary, Radiographers Board. (L.N. 90 of 2004) FORM 3 [section 13] SUPPLEMENTARY MEDICAL PROFESSIONS ORDINANCE (Chapter 359) RADIOGRAPHERS (REGISTRATION AND DISCIPLINARY PROCEDURE) REGULATION Particulars of a Company carrying on the Business of Practising Radiography Presented by ................................................................................................................. (Name of Company) of ......................................................................................................................................... (Registered Business Address) ............................................................................................................................................. (Business Registration Certificate No.) Particulars of the names and addresses of all persons who are professionally qualified directors, other directors or managers of the above company in respect of the business of radiography carried on by it at ................................................................................................ ............................................................................................................................................. under the name of ................................................................................................................. Name in full Position Certificate of Registration No. and Date of Registration where Directors are registered Part and Category registered in Residential address and of persons who practise radiography in connection with the business of the said company in the above. Name in full Residential address Occupation Qualifications Certificate of Registration No. and Date of Registration Part and Category registered in Duties Performed Dated this ........... day of ......................... 19 ........ |