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[接上页] *I/we, *a client/clients of ........................................................................................, (name of travel agent)a licensed travel agent whose licence number is ................................................................, hereby apply for an ex gratia payment from the Travel Industry Compensation Fund under section 32E of the Ordinance. 2. *My/Our personal particulars are as follows- (1) (2) (3) (4) (a) Name in English (Mr/Mrs/Miss/Ms) Name in Chinese Alias (if any) (b) Date of birth (c) Hong Kong Identity Card/Passport No. (if applicable) (d) Residential address # # # # Telephone No. Office address # # # # Telephone No. (# Please tick the appropriate box, if it is also a correspondence address.) (Paragraph 2 should be completed only by applicants who are plaintiffs in a judgement or creditors in a proof of debt. If there are more than 4 applicants, please use a photocopy.) 3. *My/Our application is in respect of a loss incurred in respect of a payment for travel services made by *me/us to the travel agent. *Moreover, *my/our application is for an amount not exceeding the specified amount. (Delete this sentence if application is not made in accordance with the simplified procedure.)- (L.N. 128 of 1997) (a) particulars of which loss are- ....................................................................................................................... ....................................................................................................................... *(b) the circumstances in which the loss occurred are- ........................................................................................................................ ........................................................................................................................ (not necessary to complete where a judgment has been obtained) 4 In support of this application, *I/we attach the following documents- (a) *One/ ................... original(s) of receipt(s) or certified true *copy/copies 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/ ...................... copies of *my/our Hong Kong Identity Card(s)/Passport(s). *(c) A sealed copy of a judgment against the travel agent given by .................................. (name of court)on ............................ (If a judgment is submitted, paragraph 6 will not be applicable.) (date of judgment)*(d) A proof of debt against the travel agent *lodged/to be lodged with ...................... (liquidator/............................................... on ........................... Official Receiver/trustee) (date) (If a proof of debt has been/is to be lodged, paragraph 6 will be applicable.) *(e) Documentary evidence of payment showing payment of the outbound fare. (L.N. 128 of 1997) *(f) Verification of payment of the outbound fare by an auditor or a person appointed by the Travel Industry Compensation Fund Management Board. (L.N. 128 of 1997) *(g) A statutory declaration stating that the payment(s) of the outbound fare(s) has (have) been made. (L.N. 128 of 1997) 5. *I/We confirm that the *judgment/proof of debt referred to in paragraph 4 has remained unsatisfied for the following reasons (in relation to a judgment, provide information together with supporting documents as to what steps have been taken to enforce the judgment)- ....................................................................................................................................... ....................................................................................................................................... ....................................................................................................................................... *6. In consideration of *my/our receiving an ex gratia payment from the Travel Industry Compensation Fund, *I/we hereby assign *my/our right(s) to receive dividends, if any, from the Official Receiver/liquidator/trustee, to the Travel Industry Compensation Fund Management Board on the understanding that where such dividend is in excess of the ex gratia payment, the excess will be paid to *me/us. In the event that *my/our proof of debt is wholly rejected or admitted only in part, *I/we hereby undertake to indemnify the Travel Industry Compensation Fund Management Board to the extent of the amount of the ex gratia payment or the difference between the amount of the ex gratia payment and 90% of the amount of the proof of debt, as the case may be. (Please see notes under paragraph 4(c) and (d).) (L.N 544 of 1996; L.N. 128 of 1997) (Delete this paragraph if application is made in accordance with the simplified procedure.) (L.N 128 of 1997) *6A. In consideration of *my/our receiving an ex gratia payment from the Travel Industry Compensation Fund, *I/we assign *my/our right(s) to receive dividends, if any, from the Official Receiver/liquidator/trustee, to the Travel Industry Compensation Fund Management Board on the undertaking that where such dividend is in excess of the ex gratia payment, the excess will be paid to *me/us. In the event that *my/our proof of debt is wholly rejected or admitted only in part, *I/we hereby undertake to indemnify the Travel Industry Compensation Fund Management Board to the extent of the amount of the ex gratia payment or the difference between the amount of the ex gratia payment and 90% of the amount of the proof of debt as the case may be. *I/We also hereby undertake to abandon *my/our claim for the excess of *my/our outbound fare made to the travel agent upon *my/our receiving an ex gratia payment from the Travel Industry Compensation Fund. |