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To: The Water Authority 43/F, Immigration Tower, 7 Gloucester Road, Wan Chai, Hong Kong e-mail: [email protected] Telephone: 2824 5000 Facsimile: 2802 7333 Application for Issue of a Grade I Plumber’s Licence Applicant Particulars: Chinese Name: Affix Photo English Surname: *Mr./Ms/Miss/Mrs 1” W English Middle/Last Name: x *HKID Card/Passport No.: 1-1/2” H Contacts: Business Phone No. : (8 digits only) Mailing Address : *Hong Kong / Kowloon / New Territories / Lamma Island / Lantau Island / Cheung Chau / Hei Ling Chau / Peng Chau / Shek Kwu Chau Street Name Street No Floor Room Building Name Block Estate/Village Phase Name/No. District Non-structural address (e.g. Foreign address, GPO Box number etc.) Civil Servant Status: □ I am not at present a civil servant. □ I am a civil servant serving in and attach a @proof. (name of department) I note Civil Service Regulations 461 to 466 and 550 to 559 on the subjects of ‘Investment’ and ‘Outside Work’ respectively. Unless approved in accordance with these Civil Service Regulations, I am not allowed to perform outside work as a Licensed Plumber. *For a staff of Water Supplies Department, I understand that permission will not be given to me to undertake paid or unpaid outside work as a Licensed Plumber in my private capacity, to avoid potential conflict with my official duties. WWO 495 (8/2005) Page 1 of 2 Qualifications: □ (A)# The Craft Certificate in Plumbing and Pipefitting issued by the Vocational Training Council after 1987. The issue date is within 5 years and 3 months before the date of application. □ (B)# The Plumbing Craft Certificate issued by the City and Guilds of London. The issue date is within 5 years before the date of application. □ (C)# *(i) The *fellowship/membership of The Institute of Plumbing and Heating Engineering (former as The Institute of Plumbing) of the United Kingdom. The issue date is within 5 years before the date of application.; or *(ii) A valid *fellowship/membership card of the Institute of Plumbing and Heating Engineering of the United Kingdom at the date of application. □ (D)+ Equivalent Qualification: (Please specify) PLUS □ (E)# Certificate in Plumbing Services (Hong Kong) issued by the Vocational Training Council. The issue date is within 5 years before the date of application. □ (F)+ Equivalent Qualification: (Please specify) Declaration: I fully understand the purpose and agree to the Water Authority using data collected from me for the purpose of or directly related to plumber’s licence. If I do not provide sufficient data, the Water Authority may not be able to process my application. I agree that these data and other related information may be transferred to other Government bureaux and departments. I understand that I can request the Departmental Secretary of the Water Supplies Department at 48/F., Immigration Tower, 7 Gloucester Road, Hong Kong for access to and correction of personal data. I fully understand and agree to the Water Authority of publishing my name (Chinese and English), plumber's licence number, grade of licence, business telephone number, licence valid till date in the gazette notices and internet. I declare that the particulars entered above are both genuine and correct. Signature: Date: Footnotes: * Delete as appropriate. @ The proof includes Government ID card, employment letter, pay slip or etc. □ Tick as appropriate. # A photocopy of the relevant qualifications must be submitted. + For qualifications item (D) or (F) mentioned above, we shall contact you for details in due course. Official Use for Remark: WWO 495 (8/2005) Page 2 of 2.

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