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[接上页] the original licence/Statement of Particulars of Business* is lost the original licence/Statement of Particulars of Business* is stolen the original licence/Statement of Particulars of Business* is destroyed the original licence/Statement of Particulars of Business* is damaged (the damaged licence/Statement of Particulars of Business has to be submitted with this application) Information on the licensee Name of the Licensee (surname first for individual) Business Name (if applicable and if different from above) I / I, on behalf of my company, sole proprietorship or partnership (as the case may be)* hereby declare that all the foregoing information is FULL, COMPLETE AND TRUE to the best of my knowledge and belief and I authorize the Estate Agents Authority to verify the fregoing information in any manner as it deems fit. _____________________________________ Date (DD/MM/YYYY) ___________________________________________ Name of Representative (for company licensee only) (in BLOCK LETTERS) _____________________________________ Estate Agent's Licence (Individual) number of Representative (for company licensee only) ___________________________________________ Signature of licensee (Authorized signature and company chop are required if the licensee is a company, a sole proprietor or a partner) (L.N. 147 of 2001) FORM 11 ESTATE AGENTS AUTHORITY APPLICATION FOR RENEWAL OF ESTATE AGENT'S LICENCE (INDIVIDUAL) Section 55(1)(c) of the Estate Agents Ordinance (Cap 511) makes it an offence punishable by a fine at level 6 and/or imprisonment for 1 year on conviction upon indictment or by a fine at level 5 and/or imprisonment for 6 months on summary conviction if a person makes any false or misleading statement or furnishes any false or misleading information in connection with an application for the grant or renewal of a licence. Note: 1) Please '?' in the appropriate box. 2) *Delete as inappropriate. Estate Agent's Licence No. Expiry Date (DD/MM/YYYY) Validity Period of Licence applied for □ 12 months □ 24 months Name in English (Surname first) Name in Chinese H.K.I.D. Card/Travel Document* No. Particulars of Applicant Note: Applicants should provide the information below only where the information is DIFFERENT from application last filed. Educational Level □ Completed F. 5 or equivalent □ Tertiary or above Alias Pass in Qualifying Examination □ Estate Agents Examination □ Salespersons Examination Registered Address ________________ ________________ ________________ _______________________________ Flat/Room Floor Block Name of Building/Estate ________________________________ Number and Name of Street _________________________ HK/KLN/NT* District Telephone No. Mobile Phone No. Fax No. Email Address Declaration Note: Questions 1 to 5 below refer to factors which will be considered in the determination for the renewal of licence. They form an integral part of this form and must be answered. Yes No 1. Are you an undischarged bankrupt or have you within the 5 years immediately prior to the date of this application made a composition or scheme of arrangement with your creditors? □ □ 2. Are you a director or officer of a company which is now disqualified under the Estate Agents Ordinance (Cap 511) for holding a licence, or were you a director or officer of that company at the date when the company was so disqualified? □ □ 3. Are you a mentally disordered person or a patient within the meaning of section 2 of the Mental Health Ordinance (Cap 136)? □ □ 4. Have you ever been convicted, whether in Hong Kong or elsewhere, on the basis of any fraudulent, corrupt or dishonest acts? □ □ 5. Have you ever been convicted under the Estate Agents Ordinance (Cap 511) in respect of which you have been sentenced to imprisonment, whether the sentence is suspended or not? □ □ If you have answered 'Yes' to any of the above questions, please give details using additional sheets. I hereby declare that for each place at which and each business name under which I am to carry on an estate agency business (if any), I have filed as part of this application an application for the grant or renewal of statement of particulars of business (Form 8 or 14), and that all the foregoing information is FULL, COMPLETE AND TRUE to the best of my knowledge and belief and I authorize the Estate Agents Authority to verify the foregoing information in any manner as it deems fit. _________________________________ Date (DD/MM/YYYY) _________________________________ Signature of Applicant (L.N. 147 of 2001) FORM 12 ESTATE AGENTS AUTHORITY APPLICATION FOR RENEWAL OF ESTATE AGENT'S LICENCE (COMPANY) / STATEMENT OF PARTICULARS OF BUSINESS Section 55(1)(c) of the Estate Agents Ordinance (Cap 511) makes it an offence punishable by a fine at level 6 and/or imprisonment for 1 year on conviction upon indictment or by a fine at level 5 and/or imprisonment for 6 months on summary conviction if a person makes any false or misleading statement or furnishes any false or misleading information in connection with an application for the grant or renewal of a licence. |