【法规名称】
【法规编号】 82167 什么是编号？
【正 文】
第10页 CAP 218F TRAVEL INDUSTRY COMPENSATION FUND (PROCEDURE FOR EX GRATIA PAYMENTS)
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[接上页] (a) Name (*Mr/Mrs/Miss/Ms) .............................................. ( ) (English) (Chinese) Alias (if any) .......................................................................................................... (b) Date of birth .......................................................................................................... (c) *Hong Kong Identity Card/Passport No. ................................................................ (d) Residential address ................................................................................................ ............................................................................................. # Telephone No. ........................... Office address ............................................................................................... ............................................................................................ # Telephone No. ........................... (# Please tick the appropriate box, if it is also a correspondence address.) 3. Particulars of my loss are- (a) medical expenses incurred in the country or place where the accident occurred- $ .................. (b) expenses incurred by my *relative(s)/former spouse for paying visits to the country or place for a purpose relating to or consequent upon my injury- (1) (2) Name of *relative/former spouse ............................... ................................ Relationship with me (in the case of a relative) ............................... ................................ Amount incurred $ ............................... ................................ 4. *(a) Neither I nor any other person has received any damages or compensation in respect of the expenses described in paragraph 3; and *(a) *I/ ....................................................................................................................... (name of recipient and relationship with me) *have/has received damages or compensation in respect of the expenses described in paragraph 3; and *(b) Neither I nor any other person has made a claim or instituted any legal proceedings in respect of those expenses.*(b) *I/ ....................................................................................................................... (name of relevant person and relationship with me) *have/has made a claim or instituted legal proceedings in respect of those expenses. *(c) Person against whom a claim has been made or legal proceedings have been instituted in respect of those expenses-.............................................................................................................................. 5. In consideration of my receiving an ex gratia payment from the Travel Industry Compensation Fund, I hereby undertake that- (a) within 30 days of the date on which I make any claim or institute any legal proceedings or any other person makes any claim or institute any legal proceedings in respect of the expenses described in paragraph 3, I shall notify the Travel Industry Compensation Fund Management Board of the full particulars of such claim or legal proceedings; (b) in the event that damages or compensation in respect of the expenses described in paragraph 3 are or is paid to me (or any other persons), I shall pay to the Travel Industry Compensation Fund Management Board the amount of the ex gratia payment or the amount of damages or compensation so paid to me, whichever is the less; and (c) in the event that the amount of the ex gratia payment is in excess of the relevant expenses (as defined in section 2 of the Travel Industry Compensation Fund (Amount of Ex gratia Payments and Financial Penalty) Rules) reasonably incurred, I shall indemnify the Travel Industry Compensation Fund Management Board to the extent of the excess. 6. I solemnly and sincerely declare that all the information given by me in this application is true and correct to the best of my knowledge and belief and I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths and Declarations Ordinance (Cap 11). .......................................... Signature of traveller Declared at .................................................................................................................. in Hong Kong this .............. day of ............. 19 ...... Before me, ................................................... Commissioner for Oaths * Delete as appropriate. (L.N. 103 of 1996; L.N. 136 of 1996; L.N. 394 of 1998) FORM E TRAVEL AGENTS ORDINANCE (Cap 218) APPLICATION FOR EX GRATIA PAYMENT IN RESPECT OF AN ACCIDENT FROM THE TRAVEL INDUSTRY COMPENSATION FUND UNDER SECTION 32E OF THE ORDINANCE (For use by an applicant applying on behalf of an infant traveller or in the case where the accident results in the death of a traveller) I, the .................................................................................................................. of |
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