【法规名称】
【法规编号】 82167 什么是编号？
【正 文】
第11页 CAP 218F TRAVEL INDUSTRY COMPENSATION FUND (PROCEDURE FOR EX GRATIA PAYMENTS)
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[接上页] (relationship with *infant/deceased traveller)............................................................................. hereby apply for an ex gratia payment (name of *infant/deceased traveller) from the Travel Industry Compensation Fund under section 32E of the Ordinance. The *infant/deceased traveller was a client of ................................................. a licensed travel (name of travel agent)agent whose licence number is .......................................... 2. My personal particulars are as follows- (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. The personal particulars of the *infant/deceased traveller are as follows- (a) Name (*Mr/Mrs/Miss/Ms) ............................................. ( ) (English) (Chinese) Alias (if any) ........................................................................................ (b) Date of birth .......................................................................................................... *Date of death ....................................................................................................... (c) *Hong Kong Identity Card/Passport No. ............................................................................................... (d) Residential address *immediately before death ...................................................................................... 4. My application is in respect of a loss incurred in respect of an accident which arises out of and in the course of an outbound travel service provided by the travel agent- (a) the circumstances in which the loss occurred are- .............................................................................................................................. .............................................................................................................................. (b) particulars of which loss are- *(i) medical expenses incurred in the country or place where the accident occurred- $ ..................... *(ii) expenses incurred in the country or place in relation to the funeral of the deceased or incurred in relation to the delivery of the dead body (including ashesafter cremation thereof) back to Hong Kong- $ ................. *(iii) expenses incurred by the *relative(s)/former spouse of the *infant/deceased for paying visits to the country or place for a purpose relating to or consequent upon the injury or death- (1) (2) Name of *relative/former spouse ............................... ................................ Relationship with the *infant/deceased (in the case of a relative) ............................... ................................ Amount incurred $ ............................... ................................ *(iv) expenses incurred by the *relative(s)/former spouse of the deceased in visiting Hong Kong for a purpose connected with the death- (1) (2) Name of *relative/former spouse ............................... ................................ Relationship with the deceased (in the case of a relative) ............................... ................................ Amount incurred $ ............................... ................................ 5. In support of the application, I attach the following documents- (a) One original receipt or certified true copy thereof duly stamped/franked to show payment of levy to the Travel Industry Compensation Fund and a total payment of $ ............... made to the travel agent. (b) A copy of my *Hong Kong Identity Card/Passport. (c) A copy of the *infant's/deceased's *Hong Kong Identity Card/Passport/birth certificate. (d) One original ....................................... showing my relationship with the *infant/deceased or certified true copy thereof. *(e) One original document showing that the accident has been reported to relevant authority of the country or place where the accident occurred. (L.N. 259 of 1997) |
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