epd.masterone.orgepd.masterone.org/images/app_isp/form_isp_e.docx.docx · Web view回收基金. The Recycling Fund (行業支援計劃) (Industry Support . Programme) 申請表格

回收基金(行業支援計劃) The Recycling Fund (Industry Support Programme)

回收基金The Recycling Fund

(行業支援計劃) (Industry Support Programme)

申請表格Application form


回收基金 The Recycling Fund

(行業支援計劃 Industry Support Programme)

申請者須知 Notes for Application

1. 「回收基金(行業支援計劃)」(以下簡稱「行業支援計劃」)於二零一五十月六日起開始接受申請。公開申請期初步訂為五年，但需視乎基金資助餘額及定期檢討結果而定。 The Industry Support Programme (ISP) of the Recycling Fund is open to application starting from 6 October 2015. The Recycling Fund will be open for application for five years subject to funding balance and periodic review.

2. 回收基金為在香港註冊的非分配利潤組織、支援機構、專業團體，研究機構、提供資助，協助它們推行非牟利項目以提升回收行業整體的操作能力和水平。The Recycling Fund provides funding support for Non-profit-distributing organizations (NPOs), industrial support organizations and professional bodies or research institutes registered in Hong Kong to undertake non-profit making projects for enhancing the operational standards and productivity of the recycling industry.

3. 非分配利潤組織包括支援機構、工商組織、專業團體、研究機構，而該機構必須是法定機構或根據香港特別行政區法律成立或註冊的組織，皆有資格申請「回收基金 (行業支援計劃 )」。Any non-profit-distributing organization operating as support organizations, trade and industrial organizations, professional bodies or research institutes, which shall either be statutory organizations or organizations registered under the laws of the Hong Kong Special Administrative Region, are eligible to apply for the Recycling Fund (Industry Support Programme).

4. 申請者應提供項目建議書，以協助提高香港回收行業的操作能力、處理量、效率、技能及回收行業的市場資訊。該項目建議書應提升回收行業整體的操作能力和水平，有利於整個行業。 Applicants should provide proposals to assist the recycling industry of Hong Kong in upgrading the overall capability, capacity, efficiency and skills as well as market information of the recycling industry. The proposal should lead to enhancement of the operational standards and productivity of the recycling industry and should benefit the industry as a whole.

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5. 申請撥款獲批後，申請表格內部份資料將有機會被上載到回收基金網站，供公眾參閱。Some information provided in this application will be made available for public information at the website of the Recycling Fund after the funding approval is given.

6. 申請者可根據《個人資料(私隱)》條例 (第 486 章)，以書面形式提出讀取及更改其於申請時提交的個人資料及其他相關資料。You have a right to request access to, and to request the correction of, the personal data and other related information you supplied in accordance with the provisions of the Personal Data (Privacy) Ordinance (Cap. 486). Such requests should be made in writing to the Secretariat.

7. 填寫申請表格前，請仔細閱讀「回收基金(行業支援計劃)」之申請指引(以下簡稱「申請指引」 ) 。 Please study the “Guide to Application for the Recycling Fund (Industry Support Programme) (the Guide to Application) carefully before completing the application form.

8. 如填寫特定資料的位置不足夠，請以附件提供相關資料。Please use attachments if the space provided for a particular item is insufficient.

9. 有意提交「行業支援計劃」申請的組織須準備以下文件：Organisations interested in applying for funding support under the Recycling Fund (Industry Support Programme) should prepare the following documents:

(i) 申請書認收通知；Acknowledgement of Receipt of Application;

(ii) 已填妥的印刷本申請表格兩份及一份電子複本(資料適宜以微軟 Word 格式儲存)；及Completed Application Form in two hard copies and one soft copy (preferably in MS Word format); and

(iii) 申請表格丁部所列的文件副本；Photocopies of the documents listed out in Section D of the Application Form.

請將以上文件郵寄或親身送交回收基金秘書處(以下簡稱「秘書處」) (即香港生產力促進局)。 Please submit the above documents to the Secretariat (the Secretariat) of the Recycling Fund (i.e. the Hong Kong Productivity Council) in person or by post. 地址：九龍塘達之路 78 號生產力大樓地下接待處Address: Reception, G/F, HKPC Building, 78 Tat Chee Avenue, Kowloon, Hong Kong.

如親身提交表格，請放於「回收基金（行業支援計劃）申請表格」收集箱。For submitting application in person, please deposit your application documents in “Recycling Fund (Industry Support Programme) Application Form Collection Box”.

秘書處收到申請後，會向申請者發出認收通知。Oct/2015(1) 2


Acknowledgement will be sent to the applicant upon receipt of an application by the Secretariat.

申請詳情可參閱「申請指引」，有關指引及申請表格可在「回收基金」的網頁下載。查詢可致電或電郵秘書處或親身到秘書處查詢。For details about application, please refer to the Guide to Application. The Guide to Application and Application Form can be downloaded from the website of the Recycling Fund. Enquiries can be directed to the Secretariat by phone, by email or in person.

地址 Address：九龍達之路 78 號生產力大樓三樓3/F, HKPC Building, 78 Tat Chee Avenue, Kowloon, Hong Kong.電話 Telephone： (852) 2788-5658傳真 Fax： (852) 3187-4559電郵 E-mail： [email protected] 網頁Website： www.recyclingfund.hk

10.由非官方人士擔任主席及各個與促進減廢和回收有關的業界人士組成的回收基金諮詢委員會(以下簡稱「委員會」)，將參考秘書處的初步評審結果進行審批。委員會將提出是否通過審批的建議、獲批金額、資助的條款及細則等，以供政府考慮。The Advisory Committee on Recycling Fund (RFAC) is chaired by a non-official and comprising non-official members drawn from different sectors relevant to the promotion of waste reduction and recycling, will further assess all applications having regard to the results of the initial assessment by the Secretariat. The RFAC will formulate its recommendations on the approval or otherwise of the applications, the amount to be supported and the terms and conditions for approving the funding, for consideration by the Government.

11.委員會一般會召開會議以評審申請。秘書處將以書面通知企業申請結果及將有關資料在回收基金網站上發布。The RFAC will usually meet for assessing the applications. The Secretariat will inform the applicants of the outcome in writing and post successful applications onto the dedicated website.

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(行業支援計劃) (Industry Support Programme)

申請書認收通知 Acknowledgement of Receipt of Application

甲部︰ ( 由申請者填寫 ) Section 1: (Completed by Applicant)

申請者名稱Name of the Applicant :

地址 Mailing Address :申請組織成立或註冊的條例Ordinance under which the Applicant is Established or Registered :

登記號碼 (如適用)Registration No. (If applicable) :

項目名稱 Project Title :電話號碼 Telephone Number :電郵 Email Address :項目統籌人姓名:Name of the Project Coordinator

乙部︰ ( 只供「回收基金秘書處」填寫 ) Section 2: (For Official Use only)

Dear Mr/Ms 先生/女士日期 Date :

本秘書處已確認收到貴組織提交以上的項目申請。We acknowledge receipt of the above Application submitted by your organisation.

(i) 日後就此申請表格與本秘書處聯絡時，請引述以下申請編號。Oct/2015(1) 4


Please quote the following application number in all future correspondences with us on the subject

Application.

申請編號 Application No:

(ii) 於本處認收信發出後 14 日內，即_______年____月____日或之前，請提交秘書處以下方格內標有〔〕的所須資料。若本處在此限期後仍未收到有關資料，會視貴組織沒有該資料，因而有可能影響項目之審批。Please provide us with the required information as ticked in the box(es) below within 14 days from the issue of this acknowledgement, i.e. on or before . If we do not receive the information by this deadline, we shall regard such information as unavailable.

申請者之登記證副本(如適用)Copy of the Registration Certificate of the Applicant (if applicable)

組織註冊證書及公司章程副本Copy of the Certificate of Incorporation and Articles of Association

項目統籌人、副統籌人、主要管理成員和技術人員的簡歷Curriculum Vitae of the project coordinator, deputy project coordinator, key management and technical staff of the project team

組織財務狀況的證明文件Supporting documents of the financial status of the organisation

預算計劃的證明文件副本（如適用）Copy of the documentary proof in support of the budget plan (if available)

其他 Others：

(iii) 如閣下對確認信有任何查詢，請與秘書處聯絡If you have any enquiries about this letter, please contact the Secretariat as follows :

地址 Address : 回收基金秘書處九龍達之路 78 號生產力大樓三樓The SecretariatThe Recycling Fund3/F, HKPC Building, 78 Tat Chee Avenue,

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Kowloon, Hong Kong.電話 Telephone : (852) 2788-5658傳真 Fax : (852) 3187-4559電郵 E-mail : [email protected]網頁Website : www.recyclingfund.hk 回收基金秘書處香港生產力促進局

The Secretariat, Recycling Fund,Hong Kong Productivity Council

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秘書處專用(Official Use Only)

收到日期 Date of Receipt

申請編號Application No


(行業支援計劃 Industry Support Programme)

申請表格 Application Form

甲部：申請者資料 1

Section A – Particulars of the Applicant 1

請在適當的空格內填上「」號或黑色Please put a “” in the appropriate boxes or fill them with black colour

1. 申請者名稱Name of the Applicant : (英文 English)

(中文 Chinese)2. 項目名稱

Project Title :

3. 項目總結(不多於 200字)Project Summary (within 200

words) :

1 The Applicant must be a non-profit-distributing organisation operating as support organisation, trade and industrial organisation, professional body or research institute, which shall either be statutory organisation or organisation registered under the laws of the Hong Kong Special Administrative Region. 申請者必須是非分配利潤組織，作為支援機構、工商組織、專業團體或研究機構，是法定機構或根據香港特別行政區的法例下註冊的組織。Oct/2015(1) 7


4. 通訊地址Mailing Address :

5. 電話 Telephone Number :( )

6. 傳真 Fax Number :( )

7. 電郵 Email Address :

8. 申請組織成立或註冊日期的條例 Ordinance under which the Applicant is

Established or Registered :9. 登記號碼（如適用）

Registration No

(if applicable) :

10. 員工數目Number of Employees :

全職 Full-time :

兼職 Part-time :

11. 成立日期 (日/月/年)Set up Date of Organisation

(dd/mm/yy) :

12. 組織的宗旨/目標Aim/Objective of the

Organisation :

13. 項目統籌人姓名及職位Name & Title of the Project

Coordinator : (英文 English)

(中文 Chinese)

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14. 組織網站（如適用）Website of the Applicant :

15. 合作組織（如適用）Collaborating Organisation(s), if any

合作組織名稱Name of Collaborating Organisation :

(英文 English)

(中文 Chinese)

地址 Address :

電話 Telephone Number : ( )

傳真 Fax Number: ( )

電郵 Email Address

商業登記號碼（如適用）Business Registration No.

(if applicable) :

成立年份Date of Establishment :

香港成員數目Number of Members in Hong Kong:

組織宗旨/目標Aim/objective of the Organisation:

項目中角色 Role in this project :

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16. 執行項目的主要成員 Key Members of the Project Team

(請按附頁的格式提交項目統籌人、副項目統籌人、主要管理成員及技術人員的簡歷) (Please enclose the curriculum vitae of the project coordinator, deputy project coordinator and key

management and technical staff of the applicant organisation according to the format at the Appendix)

(A) 項目統籌人 Project Coordinator (B) 副項目統籌人 Deputy Project Coordinator

姓名(英文)Name (English) :


姓名(中文)Name (Chinese) :


公司/機構 Company/ Organization :

公司 / 機構 Company/ Organization :

地址 Address : 地址 Address :

電話 Tel No. : 電話 Tel No.:

手提電話Mobile Phone No. :

手提電話Mobile Phone No. :

傳真 Fax No. : 傳真 Fax No. :

電郵 Email Address : 電郵 Email Address :

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乙部: 項目內容 Section B – Project Details

1. 項目名稱Project Title :

2. 推行項目所需時間(月)Project Duration (months) :

3. 項目總成本 Total Project Cost 2: (港幣HK$)

4. 申請資助金額Amount of Funding Sought 3:

(港幣HK$)

5. 申請者投入的金額或其他來源的贊助 Amount of cash contribution or sponsorship from the applicant or

other sources :

(港幣HK$)

6. 申請組織除回收基金項目以外的相關活動經驗及記錄 Experience and record of the applicant organisation in organizing related activities other than projects under the Recycling Fund

Project Title 項目名稱 : Project Description 項目詳情:

Project Duration

項目推行期:

2 項目總成本須與乙部第 9項內提供的項目總開支計算的金額一致。Total project cost needs to coincide with the total project cost in item 9 of Section B.

3 申請資助金額須與乙部第 9項內提供的申請資助金額一致。Amount of funding sought needs to coincide with the total funding sought in item 9 of Section B.

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7. 項目計劃 Project Plan

請根據「申請指引」提供下列詳細資料Please provide the following information of the project in details with reference to the Guide to Application.

(i) 回收行業面對的挑戰 / 機遇 ( 請列出項目嘗試解決的挑戰及把握的機遇 ) Challenges / opportunities faced by the recycling industry (Please state the challenges the

project tries to resolve/address and the opportunity that the project tries to seize)

(ii) 項目宗旨 ( 請說明項目如何實現回收基金的宗旨，提高回收行業的操作能力、處理量、效率、技能及市場資訊，促提升回收業員工的技能和安全水平 ) Objectives of the project (Please describe how the project achieve the objectives of the Recycling Fund to enhance the overall capability, capacity, efficiency, skills and market information and to upgrade the skills and safety of employees of the recycling industry)

(iii) 項目達致的目標和預期效果 Deliverable and the expected benefits of the projects

(iv) 項目的關鍵績效指標 ( 包括有形及 / 或無形 ) （請提供有關資料，如參加培訓課程公司的數目 / 參與者人數及研討會 / 培訓課程數目 / 提高意識等）和評審關鍵績效指標的方法 K ey performance indicators (KPI) of the project (including tangible and / or intangible) (Please provide information such as number of companies / participants attending the training course, number of seminars / training courses to be held, enhanced awareness, etc.) and method(s) for assessing the KPI(s)

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(v) 實施和宣傳計劃（請詳細描述實施方案、宣傳策略和方法，並說明計劃怎樣以具成本效益的方式實現宗旨。另外，請列出制定計劃中的所有假設）Implementation and publicity plan (Please describe in details the implementation plan,

publicity strategy, methodology and how the plan could achieve the objectives in a cost-

effective way. Please also list all the assumptions in formulating the plan.)

(vi) 財務狀況和承接項目的能力的資料 ( 請提供資料，包括項目估計的現金流、預留的項目開支及其他資金來源及金額、實物資助等開支。申請者需要按要求提供經審計帳目 / 財務報表及銀行賬單等）Information on the financial status and ability to undertake the project ( P lease provide

information including the estimated cash flow for the project, the amount reserved to deliver

the project, other source of funding, in-kind contribution, etc. The supporting document such

as audited account/financial statement, bank statement, etc. should be available upon

request.)

(vii) 項目在現時回收行業的需要和可行性 ( 請描述如果項目符合回收業的需要或項目是否適用於本地的情況或市場上有沒有其他相類似的項目在醞釀或進行中等）The need and viability of this project with reference to the current situation of the recycling

industry (For instance, please describe if the project meets the needs of the recycling industry

or if the project is applicable in local context or if there is no similar projects in the pipeline,

etc.)

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(viii) 項目成果的受惠者（請說明如何與回收業界分享項目的成果，有利於整個回收行業的發展？請填寫下面的表格。）The beneficiaries of the project deliverables (Please describe how the deliverables of the

project would be shared with the members of the recycling industry to benefit the industry

as a whole and fill in the table below.)

成果 Deliverable受惠對象Target group of

beneficiaries

受惠者數目Estimated number of

beneficiaries

接觸受惠者方式Method to reach the

beneficiaries

(ix) 從項目獲得的好處如何在項目結束後延續？ ( 請描述該項目長期的影響，如與各方建立的合作關係 ) Continuity of the benefits derived from the project after the project period? (Please describe

the long lasting effect of the project such as established collaborations with various parties)

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(x) 有關承接項目的技術和運作能力的資料 ( 請提供技術和運作能力的詳情 / 記錄，如過去的相關經驗及工作人員的相關資歷等 ) Information on the technical and operational capability to undertake the project (Please

provide details on technical and operational capability such as track record, relevant past

experience, relevant qualification of the staff, etc.):

(xi) 對項目的管理能力和承諾的資料（請提供有關管理能力的詳細資料，如項目管理、資源和人手等Information on the management capability and commitment to undertake the project (Please

provide details on management capability such as project governance, resources and

manpower to deliver the project, etc.):

請列出項目的關鍵績效指標用於監測和評估及關鍵績效指標評估方法Please list out the KPI(s) (including tangible and / or intangible) of the project for monitoring and evaluation and the method for assessing these KPI(s). 關鍵績效指標評估方法

Method for assessing the KPI(s)

關鍵指標一Key Indicator 1:

關鍵指標二

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Key Indicator 2:

關鍵指標三Key Indicator 3:

關鍵指標四Key Indicator 4:

關鍵指標五Key Indicator 5:

如超過五個關鍵指標，請以附件提供相關資料。If more than 5 key indicators, please provide as an attachment.

8. 實施和推行計劃 Implementation and Publicity Plan

請以具體和可量度的條款（包括報告和數據分析、培訓班的參加人數及研討會數目等）說明指定里程碑，及執行該計劃所需的措施/活動以及時間表。Please specify the milestone(s) in clear, specific and measurable terms (examples include reports and data analysis, number of participants attending the training course, number of seminars to be held, etc.) and the measures / activities required to implement the plan as well as the timetable involved.

里程碑(包括項目成果)Milestone(s) (including

project deliverables)

實現里程碑所需的措施/活動Measures / activities to achieve

the milestones / deliverables

開始日期 ( 日 / 月 / 年 )

Commencement Date

( dd / mm / yy )

完結日期 ( 日 / 月 / 年 )

CompletionDate

( dd / mm / yy )

1)

2)

3)

4)

5)

Oct/2015(1) 16


如超過五個里程碑，請以附件提供相關資料。If more than 5 milestones, please provide as an attachment.

Oct/2015(1) 17


9. 預算計劃 Budget Plan

a) 開支 Expenditure 4

支出項目(請每項列明) Item (Please itemize, as

appropriate)

總金額Total Amount

(港幣HK$)

項目開始後時期Period after Project

Commencement

開支項目比率(%)Percentage of Each Item in

the Total Budget開支詳情 Details of the Expense

(A) 額外人手

Additional Manpower5

(i) 員工薪金Salary of employees

Details of each additional post/employee

額外崗位 / 員工的資料 1. 職位 Position :

2. 人數No. of Persons :

主要職責Main duty : 每月/每日#薪酬Monthly/Daily# salary :

港幣HK$ /person 人工作時間Working hours : __________

總薪金 Total Salary : 港幣HK$

3. 職位 Position :

4所有的支出項目需要有詳細的分類，並必須發生在項目的開始和完成期間。申請者可根據項目的實施時間表提出每個階段的長短。All expenditure items, with detailed breakdown, must be incurred between the commencement and completion dates of the Project. The Applicant may suggest the period covered under each phase according to the implementation schedule of the project.5只有項目額外人手的薪酬（包括僱主向強制性公積金的供款）直接得到資助。員工按比例/小時計算的薪酬應每月作記錄。Only the salary (including employer’s contributions to the Mandatory Provident Fund) of the additional manpower directly incurred for the project will be funded. Monthly time sharing record should be maintained for manpower charged on a pro-rata/hourly basis.

Oct/2015(1) 18


人數No. of Persons :

主要職責Main duty : 每月/每日#薪酬Monthly/Daily# salary:

港幣HK$ /person 人工作時間Working hours : __________

總薪金 Total Salary : 港幣HK$

(#刪去不適用者)(#Please delete as appropriate)

(ii) 聘請額外員工的額外開支（如僱主支付的強積金，招聘廣告等）

Extra expenses for

employing additional staff

(e.g. MPF to be paid by

employer, advertisement for

recruitment, etc

聘請額外員工的額外開支詳情Details of extra expenses for employing

additional staff

1. 支付金額 Description : 港幣HK$

2. 支付金額 Description : 港幣HK$

原因及備註 Reasons and remarks :

小計 Subtotal (A)

Oct/2015(1) 19


Oct/2015(1) 20


(B) 額外設備Additional Equipment6

(i) 購買/租賃額外機器/設備的開支 Cost for

procuring / leasing

additional Machinery /

Equipment

購買 / 租賃額外機器 / 設備的開支詳情 Details of the expenses for procuring/leasing additional machinery/equipment

1. 機器設備名稱 (購買/租賃#)Name of Machine (Procure / Lease#):

數量 Quantity : 每台成本 Cost per unit : 港幣HK$ /unit台

總金額 Total cost : 港幣HK$

用途及與項目里程碑的直接關係Purpose and direct relationship with the

milestone(s) of the project

2. 機器設備名稱 (購買/租賃#)Name of Machine (Procure / Lease#) :

數量 Quantity:

6只有因實施項目購買或租賃的額外設備成本可獲得資助。購買或租賃設備一定要是必要的，或由項目特別要求。申請者應盡可能使用他們現有的設備。Only the cost of procuring or leasing of additional equipment for implementing the project can be charged to the funding support. Equipment proposed to be purchased or leased must be essential to or specifically required by the project. The applicant is encouraged to use their existing equipment as far as possible.

Oct/2015(1) 21


每台成本 Cost per unit 港幣HK$ /unit台

總金額 Total cost : 港幣HK$

用途及與項目里程碑的直接關係Purpose and direct relationship with the milestone(s) of the project:

(#刪去不適用者) (#Please delete as appropriate)

(ii) 購買/租賃額外機械/設備的雜費（如調試、更新、安裝，以及項目實施過程中的額外維修成本）Incidental expenses for

procuring / leasing

Machinery / Equipment

(e.g., debug, updates,

installation, and cost of

additional maintenance

during project

購買 / 租賃額外機器 / 設備的附帶開支詳情 Details of incidental expenses for procuring / leasing additional machinery / equipment

1. 細項 Description : 港幣HK$

2. 細項 Description : 港幣HK$

開支的理據及備註 Reasons and remarks:

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implementation, etc.)小計 Subtotal

(B)

(C) 其他直接開支 7

Other Direct Costs7

(i) 消耗品 Consumables

消耗品開支詳情 Details of the expenses for Consumables:

1. 細項 Description : 內容及數量 Content and quantity : 港幣HK$

用途及與項目里程碑的直接關係Purpose and direct relationship with the milestone(s) of the project :

2. 細項 Description : 內容及數量 Content and quantity: 港幣HK$


7此 “ ”項包括所有其他直接由項目衍生的費用，除支付常費及回收基金的申請指引中所不允許的成本項目。可資助的項目可包括外部的顧問費用、消耗品費用、項目成果的生產和推廣費用（如廣告及籌辦研討會）、交通費、專利登記費和外部審計費用。This includes all other costs, directly incurred for the Project, except overhead expenses and other unallowable cost items set out in the “Guide to Application for the Recycling Fund”. Fundable items may include external consultant fees, expense for consumables, production and promotion cost of project results (such as advertising and the organisation of seminars), travelling expenses, patent registration fees and external audit fees.

Oct/2015(1) 23


項目一和二的總開支Total expenses of items 1 and 2 : 港幣HK$

(ii) 委聘外部顧問的開支Cost for External Consultancy Fees

委聘外部顧問的開支詳情 : Details of the expenses for External Consultancy Fees:

1. 顧問公司名稱 Consultation Company:

工作日數Duration:

顧問費用 Consultancy Fees : 港幣HK$

用途及與項目里程碑的直接關係Purpose and direct relationship with the milestone(s) of the project :

(iii) 製作宣傳物品或舉辦宣傳活動(例如印刷宣傳單，製作光碟，舉辦研討會等)或其他相關開支Costs for production or promotion of project deliverables (e.g. printing

製作宣傳物品或舉辦宣傳活動開支詳情Details of the expenses for Production or Promotion of Project Deliverables :

1. 性質和內容 Nature and content:

Oct/2015(1) 24


of leaflets, production of CD-ROMs, organisation of seminars, etc.) or other relevant expenses

數量 Quantity: 港幣HK$


2. 性質和內容 Nature and content :

數量 Quantity : 港幣HK$


(iv)其他費用（如交通費用及外部審計費、專利登記費等）其他費用詳情 Details of other costs 1. 交通費用 Travelling Expenses :

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Other Costs (e.g. travelling expenses, external audit fees, patent registration fees, etc.)

項目成員的職銜Position of project team member :

交通工具 Type of transportation :

港幣HK$


2. 外部審計費用 External audit fees:

審計次數Number of audits:

每次審計費用 Fees per audit:

港幣HK$

總費用 Total Fees: 港幣HK$

3. 專利登記費 (與項目直接關連的專利登記費不可高於港幣二十五萬元或佔 90%的總直接成本(以較低者為準)Patent registration fees (patent registration fees directly relating to the project shall not

Oct/2015(1) 26


be more than HK$250,000 or 90% of the total direct costs involved in patent applications (whichever is less):

專利數量 Number of patents :

每個專利費用 Fees per patent : 港幣HK$

總費用 Total Fees: 港幣HK$

4. 其他費用 Other Expenses:

港幣HK$


小計 Subtotal (C)總費用

Total Expenditure(A) + (B) + (C)

若貨品或服務的供應商與申請者有任何關聯，請列明項目及提供申請者與供應商的關係，並提交理據供回收基金諮詢委員會考慮及批准（請注意：應盡可能避免向與申請企業有關連的人士或公司採購貨品或服務）

Oct/2015(1) 27


If any goods or services will be procured from a person or company / organisation with whom the applicant is associated8 , please state the item and specify the relationship with the applicant and provide justification for doing so for RFAC’s consideration and approval (please note that procurement from a person or company with whom the applicant is associated should be avoided where possible)

_______8「關聯」是指：（１）親屬（配偶，父母，子女，兄弟或有關人士的姊妹，而在推斷此種關係時，收養的子女應被視為親生父母及養父母的子女，以及過繼子女應被視為親生父母和繼父母的子女），或申請者的伴侶; （2）公司中一個或多個董事（任何人以董事為職稱，包括但不限於一個實際或影子董事）與申請者一個或多個董事相同。 “Associated” means: (1) a relative (the spouse, parent, child, brother or sister of the relevant person, and, in deducing such a

relationship, an adopted child shall be deemed to be a child both of the natural parent and the adopting parent and a step child to be a child of both the natural parent

and the step parent) or partner of the applicant; OR (2) a company one or more of whose directors (any person occupying the position of a director by whatever name

called and includes without limitation a de facto or shadow director) is in common with one or more of the directors of the applicant.

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b) 申請者的承擔及其他來源的資助Contribution from Applicant and sponsorship from other sources

Item 項目(請每項列明)(Please itemize, as appropriate)

資助方式(現金/實物)

Form of Sponsorship

(Cash/In kind)

總數 Total 備註 Remarks

(A) 申請者的承擔Contribution from Applicant

(B) 其他來源的資助Sponsorship from other sources

(C) 實物的資助In-kind contribution

總承擔Total Contribution

c) 申請金額（即總支出減去總承擔金額）Amount applied for (i.e. Total Expenditure minus Total Contribution)

申請資助 Funds applied for 總數 Total 備註Remarks

10. 項目產生收入的估計（如有的話）（請註明金額、來源、收入金額的計算方法和建議的處理方式。）9 Estimated income generated from the project (if any) (Please indicate the amount, its source, the basis on which the income figure is calculated and the proposed handling.)

____________________9 分配和使用項目產生的收入須獲得政府的書面批准。 Prior written approval from the Government should be obtained for the distribution and use of the income generated from the Project.

Oct/2015(1) 29


11. 支持相關項目申請的其他資料 Other information in support of this Application

12. 請表明此申請是否另一獲批申請項目的延伸Please indicate whether this Application is an extension of another approved project under the Recycling

Fund.

是 (請提供相關申請項目的詳細資料)Yes (please provide details of the relevant

application)

不是 No

該次申請編號Application No. of the

previous application :

請說明新項目與原本項目的協同效應和從原本項目獲得的經驗。Please highlight the synergetic effect of the new project with the original project and experience gained from the

original project.

13. 請確認此次是否重新提交先前向「回收基金」申請資助而被拒的申請？Please confirm whether this Application is a re-submission of a previously rejected application under the Recycling Fund.

是 (請提供相關申請的詳細資料)Yes (please provide details of the relevant

application)

否No

該次申請編號Application No. of the

previous application :

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請說明本申請與該次申請的主要差異，並解釋這些差異如何回應回收基金諮詢委員會及/或政府在先前評審該次申請時所提的意見和關注 Please highlight the major differences between this Application and the previous one, and explain how the

differences have addressed the comments made by the Advisory Committee on Recycling

Fund and/or the Government in previous vetting.

14. 申請組織就本申請項目或申請項目內的某些特定措施是否曾經/正在申請香港特區政府其他資助計劃的資助？ Please indicate whether you have applied / are applying for the other sources of funding support

provided by the HKSAR Government for carrying out the same proposed project / same specific

measures in the proposed plan?


application)

不是 No

項目名稱 Project Title :

政府資助計劃名稱Name of the Government Funding Scheme/Source :

申請資助金額Amount of FundingSought (港幣HK$) :

申請編號 Application No. :

提交日期 Submission Date :

審批結果Vetting Result :

獲批資助Approved

不獲批資助Rejected

審批中Still under

Oct/2015(1) 31


process

獲批資助金額 Approved Funding Amount (HK$)　(港幣HK$) :

15. 請註明閣下是否知道任何其他由第三方開展與此申請相似的項目。如適用，請描述相關項目Please state whether you are aware of any other project(s), with content similar to this application, which

have been or are being carried out by other parties. If yes, please describe the relevant project(s).


application)

不是 No

16. 請申報任何涉及與負責回收基金的政府人員、回收基金諮詢委員會委員及/或秘書處成員的個人利益，包括直接或間接，涉及金錢或其他形式的利益，無論是否與本申請有實際上或觀感上產生利益衝突。 Please disclose any personal interests, direct or indirect, pecuniary or otherwise, with any officers of the government involved in the Recycling Fund, members of the Advisory Committee on Recycling Fund and / or members of the Secretariat that may give rise to any actual or perceived conflict of interests in connection with this application.

我沒有涉及任何與此申請有抵觸，直接或間接，涉及金錢或其他形式的個人利益。I am not aware of any personal interests, direct or indirect, pecuniary or otherwise, in connection with this application. 我想申報以下個人利益

I would like to declare the following interests:

Oct/2015(1) 32


丙部: 申請者聲明及簽署 Section C – Declaration by the Applicant

本人謹代表 _______________________________________________________________ , 作出以下聲明：(一) 確認以上所申報及連同本申請書提交的所有資料，均屬真實及正確，並反映了截至提交申請書當

日的真實情況。如果對上述資料有任何更改（尤其是提交申請後獲得其他來源的資助），我承諾立即通知秘書處;及

(二) 擬推行的項目的意念不會對其他個人及／或團體的知識產權構成實質或潛在的侵權行為;及(三) 申請者須向政府賠償因該申請或項目而招致的一切損失、法律責任及申索。

I, on behalf of, , declare that

(A) all factual information provided in this application as well as the accompanying information are true and accurate and reflect the status of affairs as at the date of submission. I undertake to inform the Secretariat immediately if there are any subsequent changes to the above information (in particular, subsequent approval of funds by other public funding sources after this application is submitted); and

(B) the ideas of the proposed Project do not constitute any act or potential act of infringement of the intellectual property rights of other individuals and/or organisations; and

(C) the Applicant will indemnify the Government against all losses, liabilities and claims that it may suffer, incur or subject to in relation to this application or the Project

本人明白，倘有任何虛假聲明，可能會導致終止資助協議、退還已收取的基金撥款及面對刑事檢控。本人授權政府和秘書處按照「回收基金申請指引」處理該申請提供的個人數據/資料（如適用）。我明白秘書處會保留本申請於回收基金的登記冊，並可能於登記冊/名錄內保留個人資料及於申請表內的其他資料。本人必須根據要求，允許及配合政府和/或秘書處進行現場檢查和/或會議以確認本申請表所提供的資料，並須配合秘書處進行檢查和/或會議及提供所有文件/記錄以解釋任何事宜。本人授權秘書處/政府在必要時，與其他部門/機構/人士/團體聯絡和溝通或提供本人提交的資料予他們，以確應申請的資料。我明白如果本人申請獲得批准，會被要求與政府簽署包括條款及條件的協議。Oct/2015(1) 33


I understand that any false declaration would lead to termination of the funding agreement, refund of any funds given, and the possibility of criminal charges.

I authorise the Government and the Secretariat to handle the personal data/information provided in this form in accordance with the “Guide to Application for the Recycling Fund” if applicable. I understand that the Secretariat may keep my application in the Recycling Fund Registry and may include the personal data and other related information provided in the application form in a register / catalogue.

I shall, upon request, allow and facilitate the Government and / or Secretariat to conduct on-site inspections and / or meetings to verify the information provided in this application form and shall cooperate with the Secretariat for the proper arrangement of such inspections and / or meetings and make available all documents / records and provide explanation on any matters thereof.

I authorise the Secretariat / the Government, where necessary, to approach and communicate with other departments / organisations / persons / parties and / or provide the particulars submitted by me to these parties for the purpose of verifying the information contained in the particulars or for other purposes related to my application.

I understand that if my application is approved, I will be required to sign an agreement with the Government containing the terms and conditions of the grant.

授權人士簽署及企業印章Authorized signature with organization chop

簽署人姓名Name of signatory

申請者名稱Name of Applicant

職位Position

日期 Date

Oct/2015(1) 34


丁部–申請所需提交的文件 Section D – Checklist of Supporting Documents Required for Application

請在以下適當的空格內填上「」，以確認文件副本將連同申請書一併向「回收基金秘書處」遞交。Please put a “” in the appropriate boxes to indicate that copies of the relevant documents will be submitted

together with this Application to the Recycling Fund Secretariat.

申請企業之登記證副本(如適用)Copy of the Registration Certificate of the Applicant (if applicable)

公司註冊證書及公司章程副本Copy of the Certificate of Incorporation and Articles of Association

項目統籌人、副統籌人、主要管理成員和技術人員的簡歷Curriculum Vitae of the project coordinator, deputy project coordinator, key management and

technical staff of the project team 公司財務狀況的證明文件

Supporting documents of the financial status of the organisation 預算計劃的證明文件副本（如適用）

Copy of the documentary proof in support of the budget plan (if available)

其他 Others： _____________________________________________________________________

Oct/2015(1) 35


附錄Appendix

項目主要人員的簡歷(項目統籌人、項目副統籌人、企業主要管理人員及項目相關人員)Curriculum Vitae of Key Members of the Project Team(Project Coordinator, Deputy Project Coordinator, Key Management Personnel, Relevant Staff of the Project)

以下提供的資料將用作處理閣下於回收基金(企業資助計劃)的申請。為進行項目審批，資料將有機會向評審員、回收基金諮詢委員會委員或相關政府部門披露。閣下有權利可使用或更改於申請時提交的個人資料。若閣下希望行使這些權利，請聯絡回收基金秘書處。The information provided will be used for processing your application under the Enterprise Support Programme of the Recycling Fund (the Programme). It may be disclosed to assessors, members of the RFAC or relevant Government bureaux/departments for the purpose of vetting your application. You have the rights of access to or correction of your personal data provided in this form. If you wish to exercise such rights, please contact the Recycling Fund Secretariat.

項目統籌人 / 項目副統籌人 / 企業主要管理人員 / 項目相關人員 Project Coordinator / Deputy Project Coordinator / Key Management Personnel / Relevant Staff of the Project

個人資料 Personal Particulars


(Mr/Ms/Prof/Dr)#

# Please delete as appropriate (First Name/Last Name)


(先生/女士/教授/博士)#請刪去不適用者

職稱 Position held in Company/Organisation :

企業/組織Company/Organisation :

公司地址 Office Address :

行業性質Nature of Business :

電話Tel No. :

傳真Fax No. :

電郵Email Address :

學歷 / 專業資格 ( 按時間順序 ) Academic/Professional Qualification (in chronological order) :

Oct/2015(1) 36


相關工作資格 ( 按時間順序 ) Relevant Working Qualification (in chronological order) : (包括項目管理經驗，如適用 Project management experience, if any, should be included

Oct/2015(1) 37