Sfaa

 Sfaa Composition

由辦事處填寫 For Workplace Use Only

持續進修基金申請表 CONTINUING EDUCATION PAY FOR (CEF) APPLICATION FORM

Date

one particular

No

being unfaithful

在填寫表格前請先參閱『申請指引』[SFAA191C (2012)]。請用黑色或深藍色原子筆,以正楷填寫本表格。 Please label the " Guidance Notes” [SFAA191 (2012)] and complete most items in block letters with a blue or black pen. 如申請人的持續進修基金開戶申請已獲得初步批准,便不需於其他" 可獲發還款項課程”開課前再遞交第二份申請。 Applicants who have received approval in-principle for starting an account with CEF do not need to submit another application prior to commencement of other reimbursable course(s). 甲部 PART A 中文姓名(如適用) Term in Oriental: (if applicable) 英文姓名 Brand in British:

個人資料 PERSONAL DATA

中文電碼 Chinese Personality Code: 16 (請靠左填寫 Left-justified)

姓名 Identity

40 (請靠左填寫─先填姓氏,後填名字 Left-justified – Surname first, then Various other Name)

稱謂 Title: 先生 Mr. 女士 Ms. 小姐 Miss

=1 =2 =3

75

香港智能身份證號碼 Hong Kong Intelligent Identity Credit card No .:

76 (請靠右填寫 Right-justified)

(

)

出生日期 Day of Birth:

85 Deb D Meters M

1 9

Y Y Y Y

通訊地址 Correspondence Treat: (請用正楷填寫,如住址與通 訊地址不同,請在本頁丁部 「申請人附加資料」填報住 址) Please total in English language block albhabets. If your home address is usually not the same as the correspondence treat, please reveal your home address partly D – ‘Additional Info of Applicant' below. )

室 Level

93

層 Floor

98

座 Block

101

104 大廈名稱 Term of Building

134 屋邨 / 屋苑 Estate / The courtroom (請靠左填寫 Left-justified) 街號及街名 Number & Name of Avenue, 地區 Region 194 1 – 香港 HK, a couple of – 九龍 KLN, a few – 新界 N. Big t. 其他聯絡電話號碼 (例如流動電話 / 傳呼號碼) 203 Various other Contact Mobile phone No .: (e. g. cellular phone / pager)

164

住宅電話號碼 Residential Mobile phone No .:

195

你是否學位持有人? Will you be a degree holder?

是 " Y”; 否 " N” Yes " Y”; Simply no " N”

215

乙部 PART W

就讀課程資料 INFORMATION ON COURSE OF STUDY

院校 / 辦學機構名稱 Name of Institution as well as Course Company: 持續進修基金院校編號 CEF Institution Code: 持續進修基金課程名稱 CEF Course Subject:

持續進修基金課程編號 CEF Course Code:

實際由申請人繳付的學費 Genuine Tuition Service fees paid by the applicant: 開課日期 (日/月/年) Commencement Date (D/M/Y): 216

HK$

D Deb M Meters Y Con Y Y

注意事項/Attention: 1 ) 申請人須於開課日期前遞交申請至持續進修基金辦事處。 Applicant should submit the application to the Office of the Training Fund before the course commences. 2 . 除獲勞工及福利局局長豁免外,所有" 可獲發還款項課程"必須以按月等額形式收取學費。有關已獲豁免的課程名單, 請瀏覽基金網頁 (www.sfaa.gov.hk/cef)。 The tuition costs of all " reimbursable courses” must be accumulated on the same monthly payments basis besides those which have already been granted permission by the Admin for the Labour and Welfare Bureau. For the list of exempted courses, much more CEF internet site (www.sfaa.gov.hk/cef). 由辦事處填寫 For Business office Use Only

HKID OTH

224

ADD

225

SIGN

226

CERT CLOSED CIRCUIT

227

ALTERNATING CURRENT

228

VP

229 Prepared by:

AG

230 Inspected by:

RS

231

232

IC

235

238

SFAA 192 (2012)

-1-

轉後頁 P. To. O.

丙部 PART C 院校 as well as 辦學機構證明 QUALIFICATION BY THE INSTITUTION / PROGRAM PROVIDER 申請人在遞交申請前須先將申請表交予院校 / 辦學機構填寫及蓋章。 Applicants should submit the shape to the establishment for documentation and conclusion before submitter. 茲證明 as well as This is to certify that ﹕ 1 ) 申請人已被取錄修讀乙部所申報之課程,而申請人於本申請表上所提供有關課程的資料均屬正確無訛;及 The applicant has enrolled in the course as stated in Part N and the details given in this kind of Application Form in respect of the training course provided by the applicant happen to be correct; and 2 . 申請人並不是大學教育資助委員會(教資會)資助課程的學生;或申請人是教資會資助課程的學生,惟於乙部所 申報之課程學費並不屬於繳付教資會資助課程學費的一部份 (只適用於受教資會資助的院校)。 The candidate is not really a student of University Scholarships Committee (UGC)-funded programme(s); or maybe the applicant is known as a student of UGC-funded programme(s) but the expenses fees pertaining to the study course as stated simply B is usually not part of the tuition service fees for the UGC-funded programme(s) s/he enrolled (Only applicable to UGC-funded institutions). 日期 Date: 院校 / 辦學機構印� Stamp Chop of Establishment

丁部 COMPONENT D

申請人附加資料 ADDITIONAL INFORMATION OF APPLICANT

(如有需要,可另加紙補充 Use independent sheet if necessary)

戊部 PART E

本人

聲明書 DECLARATION

,擁有香港特別行政區 (香港) 居留權/香

,持香港智能身份證號碼 (申請人姓名) 港入境權/獲准逗留香港的許可而不受任何逗留條件的限制/持單程證從中國大陸來港定居。 My spouse and i,

, holder of Hong Kong Clever Identity Cards No ., have...

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