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[接上页] 8. I declare that- (a) I have been authorized by the traveller(s)- (i) to act on *his behalf/behalf of each of them in applying for and receiving ex gratia payments from the Fund; and (ii) to assign on *his behalf/behalf of each of them his right to receive dividends from the Official Receiver/liquidator/trustee; and(b) all the information given by me in this application is true and correct to the best of my knowledge and belief. Signature of authorized Applicant: .................................. Date: .................................. * Delete as appropriate. NOTES 1. The applicant is advised to read Part IIIA of the Travel Agents Ordinance (Cap 218) before submitting this application. 2. Additional information and documentary evidence may be required in support of this application. 3. This application must be submitted to the Secretary of the Travel Industry Compensation Fund Management Board or the person appointed under section 3B(1)(b) of the Travel Industry Compensation Fund (Procedure for Ex gratia Payments) Rules within 24 months beginning on the date the outbound traveller(s) first sustained his/her/their loss/losses. 4. The Travel Industry Compensation Fund Management Board shall have absolute discretion to refuse any application for ex gratia payment. 5. This form must be completed in duplicate and sent by post or delivered in person to the Secretary of the Travel Industry Compensation Fund Management Board at the following address- Travel Agents Registry, 8/F, West Wing, Central Government Offices, Lower Albert Road, Hong Kong. or the person appointed under section 3B(1)(b) of the Travel Industry Compensation Fund (Procedure for Ex gratia Payments) Rules at the following address- ANNEX PERSONAL PARTICULARS AND AUTHORIZATION(S) OF THE TRAVELLER(S) (To be completed by the traveller(s)) *I/We, each and everyone of us at .......................................................................... ....................................................................................................................................... (address)(Telephone No.: ............................) provide *my/our personal particulars hereunder and declare by appending *my/our signature(s) against *my/our respective personal particulars that *I/we authorize the person named hereunder to act on *my/our behalf in applying for and receiving ex gratia payments from the Travel Industry Compensation Fund and to assign to the Travel Industry Compensation Fund Management Board the right of *mine/each of us to receive dividends, if any, from the Official Receiver/liquidator/trustee. 2. The personal particulars of the person authorized to act on *my/our behalf are as follows- (a) Name (English & Chinese) ..................................................................................... (b) *Hong Kong Identity Card/Passport No. ................................................................. (c) Residential address ................................................................................................ ................................................................ Telephone No.: ..................................... 3. (See Note 1) By appending *my/our signature(s) hereunder, *I/we and everyone of us also declare that, in the event that *my/our proof of debt is wholly rejected or admitted only in part, *I/we 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(s) for the excess of *my/our outbound fare(s) made to the travel agent upon *my/our receiving the ex gratia payment from the Travel Industry Compensation Fund. (Delete this sentence if application is not made under the simplified procedure.) * Delete as appropriate. Name (English & Chinese) Hong Kong Identity Card/Passport No. Residential address & Telephone No. Amount paid to travel agent $ Signature 1 ................ .................... .................... .................... .................... 2 ................ .................... .................... .................... .................... 3 ................ .................... .................... .................... .................... 4 ................ .................... .................... .................... .................... 5 ................ .................... .................... .................... .................... 6 ................ .................... .................... .................... .................... 7 ................ .................... .................... .................... .................... 8 ................ .................... .................... .................... .................... |