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[接上页] (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) One original document showing that the accident has been reported to the relevant authority of the country or place where the accident occurred.(d) *One/ ............ original(s) of receipt(s) for the expenses described in paragraph 3(b). *(e) *One/ ............ original(s) of receipt(s) for the damages or compensation received in respect of the expenses described in paragraph 3(b). 5. *(a) Neither I nor any other person has received any damages or compensation in respect of the expenses described in paragraph 3(b); 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(b); 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- ............................................................................................................. 6. 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 institutes any legal proceedings in respect of the expenses described in paragraph 3(b), 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(b) are or is paid to me or any other person, 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. 7. 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 applicant Declared at .................................................................................................................. in Hong Kong this ............... day of ............. 19 ...... Before me, ................................................ Commissioner for Oaths * 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 3(5)(a) of the Travel Industry Compensation Fund (Procedure for Ex gratia Payments) Rules within 24 months beginning on the date of the accident. 4. The Travel Industry Compensation Fund Management Board shall have absolute discretion to determine the amount of, or 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 3(5)(a) of the Travel Industry Compensation Fund (Procedure for Ex gratia Payments) Rules at the following address- (L.N. 103 of 1996; L.N. 136 of 1996; L.N. 394 of 1998) FORM D 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 acting on behalf of an outbound traveller) I hereby apply for an ex gratia payment from the Travel Industry Compensation Fund under section 32E of the Ordinance on behalf of .................................................. who was a client of ............................................. (name of travel agent), a licensed travel agent whose licence number is. .............................................................................................................. |