申请加入中国国籍 (供十八岁以下人士使用) Application for Naturalization as a Chinese National (For persons aged under 18) 香港特别行政区入境事务处 Immigration Department Hong Kong Special Administrative Region 此栏由办理机关填写 FOR OFFICIAL USE ONLY 申请资料条码 Application reference barcode 申请类别简码 申请日期 Nature Code Application date 批核简码 批核日期 Result Code Result date 注意 填写此表格前,请先阅读申请手续说明书 (ID 874A 款). IMPORTANT Please read the Guide for Applicants (ID 874A) before completing this form. 请以正楷填写.倘表格内的空位不敷应用,可用另一张纸填写. Please write in BLOCK LETTERS. If there is not enough space for your answer, use a separate sheet of paper. 警告 明知而蓄意在本表格内提供虚假资料或作出虚假陈述,即属违法. WARNING To give false information or make false statements on this form knowingly is an offence under the law. 获准加入中国国籍者,不得保留外国国籍. A person whose application for naturalization as a Chinese national has been approved shall not retain foreign nationality. 1. 若以前曾递交申请书或函件,请注明日期及本处档号. Please give here date and Immigration Department reference number of any previous application or correspondence. 2. 该儿童个人资料 Personal particulars of the child 先生 小姐 太太 女士 Mr Miss Mrs Ms 中文姓名 婚前姓氏 (如适用者) Name in Chinese Maiden surname (if applicable) 英文姓名 Full name in English 别名 (如适用者) Alias (if applicable) 出生日期 出生地点 Date of birth Place of birth 香港永久性居民身份证号码/ 香港身份证号码 HK permanent identity card no./ HK identity card no. 婚姻状况 未婚 已婚 合法分居 离婚 丧偶 Marital status single married legally separated divorced widowed 职业 日间电话号码 Occupation Daytime tel. no. 住址 Address 现时国籍 旅行证件种类及号码 Present nationality Type and number of travel document 如本表格为影印本或从互联网下载, 请填写此栏. Please complete this column if this form is a photocopy or downloaded copy. 就本人所知及相信,在本页内所提供的各项资料,均属正确、完备和真实. The information given in this page is true, complete and correct to the best of my knowledge and belief. 日期 申请人的 父/ 母/ 合法监护人签署: Date:Signature of applicant's father/ mother/ legal guardian: 请在适当方格内填上「?」号Please tick in the appropriate box ID 875 (06/2011) 3. 配偶 (如适用者) Spouse (if applicable) 配偶 (婚前) 姓名 中文姓名 英文姓名 Full name of spouse Name in Chinese Name in English (before marriage) 配偶的出生日期、地点及国家 配偶的国籍 Spouse's date, place and country of birth Spouse's nationality 配偶的现时住址 Spouse's present address 你的配偶是否同时申请加入中国国籍? 是否Has your spouse jointly applied for naturalization as a Chinese national with you? Yes No (如果是,请注明档案号码) (If yes, please quote the reference number) 4. 父母 Parents 父亲的中文姓名 父亲的英文姓名 Father's name in Chinese Father's name in English 父亲的出生日期、地点及国家 父亲现时的国籍 Father's date, place and country of birth Father's present nationality 母亲的中文姓名 母亲的英文姓名 Mother's name in Chinese Mother's name in English 母亲的出生日期、地点及国家 母亲现时的国籍 Mother's date, place and country of birth Mother's present nationality 5. 子女:所有在香港或其他国家居住的子女详情 (如适用者) Children: Particulars of all children living in Hong Kong or any other country (if applicable) 如同时申请加入中国国籍, 中英文姓名 出生日期 现时国籍 请注明档号 Name in 性别 及地点 职业 现时住址 Present If applied for naturalization as a Chinese and Sex Date and place Occupation Present address nationality Chinese national at the same time, English of birth please give reference number 6. 兄弟姊妹:所有在香港或其他国家居住的兄弟姊妹详情 Siblings: Particulars of all siblings living in Hong Kong or any other country 如同时申请加入中国国籍, 中英文姓名 出生日期 现时国籍 请注明档号 Name in 性别 及地点 职业 现时住址 Present If applied for naturalization as a Chinese and Sex Date and place Occupation Present address nationality Chinese national at the same time, English of birth please give reference number 如本表格为影印本或从互联网下载, 请填写此栏. Please complete this column if this form is a photocopy or downloaded copy. 就本人所知及相信,在本页内所提供的各项资料,均属正确、完备和真实. The information given in this page is true, complete and correct to the best of my knowledge and belief. 日期 申请人的 父/ 母/ 合法监护人签署: Date:Signature of applicant's mother/ legal guardian: father/ 请在适当方格内填上「?」号Please tick in the appropriate box 7. 如该儿童曾被法庭 (在香港或海外) 判处有罪,请详述於后.倘他/她从未被判有罪,请在左栏内填 写「无」字. If the child has been convicted in a court of law (in or out of Hong Kong) of any crime or offence, please give the details below. If he/she has not been convicted, write "NONE" in the left hand column. 罪行/犯法行为 判决 法庭 判决日期 Crime/Offence Sentence Court Date of sentence 8. 详列该儿童在过去七年内的所有住址 (包括香港以外地区住址) Give below all the child's addresses for the last 7 years (including addresses outside Hong Kong) 详细地址 日期由 至Full address Date from Date to 初次抵港日期 Date of first arrival in Hong Kong 旅行证件号码 由 签发 Travel document number issued by 9. 请说明该儿童在加入中国国籍后计划居住的地方 Please state in which place the child will live if naturalized. 10. 十八岁或以上的近亲属 (如适用者) Near relative who is aged 18 or over (if applicable) 本人 (近亲属姓名)现居(详细住址) 於 (出生日期) 在 (出生地点)出生,系中国公民,持有香港永久性居民身份证, 号码 本人为 (第二栏内所载儿童姓名) 的 (关系) 并支持 他/ 她申请加入中国国籍. I, (near relative's full name in BLOCK LETTERS)of (full address) born on (date of birth)at (place and country of birth)am a Chinese national holding Hong Kong permanent identity card, no.I am the (relationship) of (name of the child in Part 2)and I support his / her application for naturalization as a Chinese national. 日间电话号码 Daytime telephone number_ 近亲属签署 日期 Signature of near relative_Date 如本表格为影印本或从互联网下载, 请填写此栏. Please complete this column if this form is a photocopy or downloaded copy. 就本人所知及相信,在本页内所提供的各项资料,均属正确、完备和真实. The information given in this page is true, complete and correct to the best of my knowledge and belief. 日期 申请人的 父/ 母/ 合法监护人签署: Date:Signature of applicant's mother/ legal guardian: father/ 请在适当方格内填上「?」号Please tick in the appropriate box 11. 请说明支持该儿童申请加入中国国籍的理由 (如有者) Please state the reasons (if any) to support the child's application for naturalization as a Chinese national. 12. 声明 (十八岁以下人士必须由父或母或合法监护人作出以下声明) Declaration (For applicant aged under 18, this declaration has to be made by parents or legal guardian) 本人,即下开签署人,现谨此声明: I, the undersigned, declare that: (1) 本人是第二栏内所载儿童的 父/ 母/ 合法监护人. I am the father/ mother/ legal guardian of the child named in Part 2. (2) 就本人所知及相信,在本申请书内所提供的各项资料,均属正确、完备和真实. The information given in this application is true, complete and correct to the best of my knowledge and belief. (3) 在本申请审查期间,如情况有任何改变以致影响本申请书内各项资料的准确性,本人承诺以书面通知入境事务处处长. I undertake to inform the Director of Immigration in writing of any change in circumstances which may affect the accuracy of the information given while this application is being considered. (4) 在第二栏内所载儿童获得批准加入中国国籍后,其不會保留外国国籍. The child named in Part 2 shall not retain foreign nationality on becoming a Chinese national. (5) 本人同意为办理此项申请所须进行的任何查询. I consent to the making of any enquiries necessary for the processing of this application. (6) 本人同意为处理此项申请而向任何在香港特别行政区境内或境外的政府机关、公共机构或私营机构提供本申请书内所 提供的资料. I consent to the release of the information given in this application to any government authorities, public bodies or private organizations which are within or outside the Hong Kong Special Administrative Region for the processing of this application. (7) 本人现授权所有在香港特别行政区境内或境外的政府机关、公共机构或私营机构向香港特别行政区政府入境事务处提 供为处理此项申请所需的任何记录或资料. I authorise all government authorities, public bodies or private organizations which are within or outside the Hong Kong Special Administrative Region to release to the Immigration Department of the Government of the Hong Kong Special Administrative Region any record or information which the Immigration Department may require for the processing of this application. 日期 姓名及签署 Date Name and Signature_ 此栏由办理机关填写 For official use only 备注 Remarks 首次缴费 Initial payment 余额缴费 Balance payment 费用 Fee paid $ 费用 Fee paid $ 收款员姓名及签署 Shroff's name and signature 收款员姓名及签署 Shroff's name and signature 收據号码 Receipt no. 收據号码 Receipt no. 日期 Date 日期 Date 领取证书时用 For acknowledgment of receipt of certificate 本人已领取加入中国国籍证书,号码 I have received a Certificate of Naturalization, no. 证书领取人姓名及签署 领取证书日期 Name and signature of recipient Date of receiving certificate 签发证书 Issue of certificate 已完成签发加入中国国籍证书 Issue of a Certificate of Naturalization has been completed. 签发职员姓名、职位及签署 日期 Name, post and signature of issuing officer Date 请在适当方格内填上「?」号Please tick in the appropriate box
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申请加入中国国籍 (供十八岁以下人士使用) Application for Naturalization as a Chinese National (For persons aged under 18) 香港特别行政区入境事务处 Immigration Department Hong Kong Special Administrative Region 此栏由办理机关填写 FOR OFFICIAL USE ONLY 申请资料条码 Application reference barcode 申请类别简码 申请日期 Nature Code Application date 批核简码 批核日期 Result Code Result date 注意 填写此表格前,请先阅读申请手续说明书 (ID 874A 款). IMPORTANT Please read the Guide for Applicants (ID 874A) before completing this form. 请以正楷填写.倘表格内的空位不敷应用,可用另一张纸填写. Please write in BLOCK LETTERS. If there is not enough space for your answer, use a separate sheet of paper. 警告 明知而蓄意在本表格内提供虚假资料或作出虚假陈述,即属违法. WARNING To give false information or make false statements on this form knowingly is an offence under the law. 获准加入中国国籍者,不得保留外国国籍. A person whose application for naturalization as a Chinese national has been approved shall not retain foreign nationality. 1. 若以前曾递交申请书或函件,请注明日期及本处档号. Please give here date and Immigration Department reference number of any previous application or correspondence. 2. 该儿童个人资料 Personal particulars of the child 先生 小姐 太太 女士 Mr Miss Mrs Ms 中文姓名 婚前姓氏 (如适用者) Name in Chinese Maiden surname (if applicable) 英文姓名 Full name in English 别名 (如适用者) Alias (if applicable) 出生日期 出生地点 Date of birth Place of birth 香港永久性居民身份证号码/ 香港身份证号码 HK permanent identity card no./ HK identity card no. 婚姻状况 未婚 已婚 合法分居 离婚 丧偶 Marital status single married legally separated divorced widowed 职业 日间电话号码 Occupation Daytime tel. no. 住址 Address 现时国籍 旅行证件种类及号码 Present nationality Type and number of travel document 如本表格为影印本或从互联网下载, 请填写此栏. Please complete this column if this form is a photocopy or downloaded copy. 就本人所知及相信,在本页内所提供的各项资料,均属正确、完备和真实. The information given in this page is true, complete and correct to the best of my knowledge and belief. 日期 申请人的 父/ 母/ 合法监护人签署: Date:Signature of applicant's father/ mother/ legal guardian: 请在适当方格内填上「?」号Please tick in the appropriate box ID 875 (06/2011) 3. 配偶 (如适用者) Spouse (if applicable) 配偶 (婚前) 姓名 中文姓名 英文姓名 Full name of spouse Name in Chinese Name in English (before marriage) 配偶的出生日期、地点及国家 配偶的国籍 Spouse's date, place and country of birth Spouse's nationality 配偶的现时住址 Spouse's present address 你的配偶是否同时申请加入中国国籍? 是否Has your spouse jointly applied for naturalization as a Chinese national with you? Yes No (如果是,请注明档案号码) (If yes, please quote the reference number) 4. 父母 Parents 父亲的中文姓名 父亲的英文姓名 Father's name in Chinese Father's name in English 父亲的出生日期、地点及国家 父亲现时的国籍 Father's date, place and country of birth Father's present nationality 母亲的中文姓名 母亲的英文姓名 Mother's name in Chinese Mother's name in English 母亲的出生日期、地点及国家 母亲现时的国籍 Mother's date, place and country of birth Mother's present nationality 5. 子女:所有在香港或其他国家居住的子女详情 (如适用者) Children: Particulars of all children living in Hong Kong or any other country (if applicable) 如同时申请加入中国国籍, 中英文姓名 出生日期 现时国籍 请注明档号 Name in 性别 及地点 职业 现时住址 Present If applied for naturalization as a Chinese and Sex Date and place Occupation Present address nationality Chinese national at the same time, English of birth please give reference number 6. 兄弟姊妹:所有在香港或其他国家居住的兄弟姊妹详情 Siblings: Particulars of all siblings living in Hong Kong or any other country 如同时申请加入中国国籍, 中英文姓名 出生日期 现时国籍 请注明档号 Name in 性别 及地点 职业 现时住址 Present If applied for naturalization as a Chinese and Sex Date and place Occupation Present address nationality Chinese national at the same time, English of birth please give reference number 如本表格为影印本或从互联网下载, 请填写此栏. Please complete this column if this form is a photocopy or downloaded copy. 就本人所知及相信,在本页内所提供的各项资料,均属正确、完备和真实. The information given in this page is true, complete and correct to the best of my knowledge and belief. 日期 申请人的 父/ 母/ 合法监护人签署: Date:Signature of applicant's mother/ legal guardian: father/ 请在适当方格内填上「?」号Please tick in the appropriate box 7. 如该儿童曾被法庭 (在香港或海外) 判处有罪,请详述於后.倘他/她从未被判有罪,请在左栏内填 写「无」字. If the child has been convicted in a court of law (in or out of Hong Kong) of any crime or offence, please give the details below. If he/she has not been convicted, write "NONE" in the left hand column. 罪行/犯法行为 判决 法庭 判决日期 Crime/Offence Sentence Court Date of sentence 8. 详列该儿童在过去七年内的所有住址 (包括香港以外地区住址) Give below all the child's addresses for the last 7 years (including addresses outside Hong Kong) 详细地址 日期由 至Full address Date from Date to 初次抵港日期 Date of first arrival in Hong Kong 旅行证件号码 由 签发 Travel document number issued by 9. 请说明该儿童在加入中国国籍后计划居住的地方 Please state in which place the child will live if naturalized. 10. 十八岁或以上的近亲属 (如适用者) Near relative who is aged 18 or over (if applicable) 本人 (近亲属姓名)现居(详细住址) 於 (出生日期) 在 (出生地点)出生,系中国公民,持有香港永久性居民身份证, 号码 本人为 (第二栏内所载儿童姓名) 的 (关系) 并支持 他/ 她申请加入中国国籍. I, (near relative's full name in BLOCK LETTERS)of (full address) born on (date of birth)at (place and country of birth)am a Chinese national holding Hong Kong permanent identity card, no.I am the (relationship) of (name of the child in Part 2)and I support his / her application for naturalization as a Chinese national. 日间电话号码 Daytime telephone number_ 近亲属签署 日期 Signature of near relative_Date 如本表格为影印本或从互联网下载, 请填写此栏. Please complete this column if this form is a photocopy or downloaded copy. 就本人所知及相信,在本页内所提供的各项资料,均属正确、完备和真实. The information given in this page is true, complete and correct to the best of my knowledge and belief. 日期 申请人的 父/ 母/ 合法监护人签署: Date:Signature of applicant's mother/ legal guardian: father/ 请在适当方格内填上「?」号Please tick in the appropriate box 11. 请说明支持该儿童申请加入中国国籍的理由 (如有者) Please state the reasons (if any) to support the child's application for naturalization as a Chinese national. 12. 声明 (十八岁以下人士必须由父或母或合法监护人作出以下声明) Declaration (For applicant aged under 18, this declaration has to be made by parents or legal guardian) 本人,即下开签署人,现谨此声明: I, the undersigned, declare that: (1) 本人是第二栏内所载儿童的 父/ 母/ 合法监护人. I am the father/ mother/ legal guardian of the child named in Part 2. (2) 就本人所知及相信,在本申请书内所提供的各项资料,均属正确、完备和真实. The information given in this application is true, complete and correct to the best of my knowledge and belief. (3) 在本申请审查期间,如情况有任何改变以致影响本申请书内各项资料的准确性,本人承诺以书面通知入境事务处处长. I undertake to inform the Director of Immigration in writing of any change in circumstances which may affect the accuracy of the information given while this application is being considered. (4) 在第二栏内所载儿童获得批准加入中国国籍后,其不會保留外国国籍. The child named in Part 2 shall not retain foreign nationality on becoming a Chinese national. (5) 本人同意为办理此项申请所须进行的任何查询. I consent to the making of any enquiries necessary for the processing of this application. (6) 本人同意为处理此项申请而向任何在香港特别行政区境内或境外的政府机关、公共机构或私营机构提供本申请书内所 提供的资料. I consent to the release of the information given in this application to any government authorities, public bodies or private organizations which are within or outside the Hong Kong Special Administrative Region for the processing of this application. (7) 本人现授权所有在香港特别行政区境内或境外的政府机关、公共机构或私营机构向香港特别行政区政府入境事务处提 供为处理此项申请所需的任何记录或资料. I authorise all government authorities, public bodies or private organizations which are within or outside the Hong Kong Special Administrative Region to release to the Immigration Department of the Government of the Hong Kong Special Administrative Region any record or information which the Immigration Department may require for the processing of this application. 日期 姓名及签署 Date Name and Signature_ 此栏由办理机关填写 For official use only 备注 Remarks 首次缴费 Initial payment 余额缴费 Balance payment 费用 Fee paid $ 费用 Fee paid $ 收款员姓名及签署 Shroff's name and signature 收款员姓名及签署 Shroff's name and signature 收據号码 Receipt no. 收據号码 Receipt no. 日期 Date 日期 Date 领取证书时用 For acknowledgment of receipt of certificate 本人已领取加入中国国籍证书,号码 I have received a Certificate of Naturalization, no. 证书领取人姓名及签署 领取证书日期 Name and signature of recipient Date of receiving certificate 签发证书 Issue of certificate 已完成签发加入中国国籍证书 Issue of a Certificate of Naturalization has been completed. 签发职员姓名、职位及签署 日期 Name, post and signature of issuing officer Date 请在适当方格内填上「?」号Please tick in the appropriate box