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就建築物條例第40(1BD)條所訂罪行的法律責任提出爭議通知 Notification on Dispute of Liability for the Offence under Section 40(1BD) of the Buildings Ordinance 《建築物條例》(第 123 章) 附表 7 第 1(b)條 Buildings Ordinance (Chapter 123) Section 1(b) of Schedule 7

表格 Form

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•本通知須於罰款通知書的日期後21天內呈交。• 請以正楷填寫，並在適當方格內加上『√』號。填寫前，請細閱《注意事項》。• Submit this notification within 21 days after the date of the Penalty Notice.• Read the “Matters to Note”, complete in BLOCK LETTERS and tick the appropriate boxes.

致建築事務監督 To the Building Authority

Details of the Penalty Notice 關於以下罰款通知書，本人欲就《建築物條例》第40(1BD)條所訂罪行的法律責任提出爭議。I wish to dispute the liability for the offence under section 40(1BD) of the Buildings Ordinance with reference to the following Penalty Notice.

處所地址 Address of Premises

區域 Area

香港 Hong Kong

九龍 Kowloon

新界 New Territories

地區 District

街道/鄉 Street/Village

街道號碼 Street No.

大廈/屋苑 Building/Estate

樓層 Floor

單位/室 Flat/Room

或 詳細位置 Or Detailed Location (例如: 停車場、天台、店舖等 e.g. car park, roof, shop, etc.)

通知書日期 Notice Date

日 dd 月 mm 年 yyyy

罰款通知書編號 Penalty Notice No.

檔案編號 File Reference

2 申請人的詳情Particulars of the Applicant

中文姓名 Name in Chinese 姓氏先行 Surname first

英文姓名 Name in English 姓氏先行 Surname first

身份証明 Identification香港身份證號碼: HKID No.:商業登記號碼: Business Registration No.:

通訊地址 Correspondence Address

聯絡電話 Contact Tel. No.

電郵地址^ E-mail Address^

^ 作認收電郵之用 (電子呈交適用) ^ For acknowledgement email (e-submission)

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1 罰款通知書的資料

3 提出爭議的理由Grounds for Lodging the Dispute

本人已閱讀隨附函件第2段及下文的備註，並明白本人在是次法律爭議中的權利和義務。I have read paragraph 2 in the covering letter and the notes below regarding dispute of liability and understand my rights and obligations in entering this legal dispute.

本人提出爭議的理由 Grounds for Lodging the Dispute

如有需要，請另頁書寫。 Use a separate sheet if necessary.

本人已閱讀並同意於《注意事項》內所列之條款。 I have read and hereby agree the terms and conditions as stated in the “Matters to Note” section.

簽署 Signature

任何失實核證或聲明可引致法律行動。##

Any false certification or declaration may be subject to legal action.##

日期 Date

日 dd 月 mm 年 yyyy

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注意事項 注意事項 Matters to Note Matters to Note

## 任何人如作出虛假證明/聲明或就重要事實作出失實陳述即屬犯罪，當局在適用的情況下可予檢控或採取紀律行動。

1. 如欲投訴、查詢、申請延期，或通知建築事務監督已完成強制驗窗計劃通知所規定進行的訂明工程，請勿使用本表格。請用隨附罰款通知書第8段所載的電話號碼或以另頁致函屋宇署。

2. 你通知建築事務監督欲就法律責任提出爭議後，當局可對你提起法律程序，而在該法律程序中發出的傳票，可按照《裁判官條例》(第227章) 第8條向你送達。

3. 在法律程序提起後但有關傳票指明你須出庭日期的至少2天 (任何公眾假日除外) 前，你可在任何裁判法院繳付定額罰款1,500元及訟費500元，並同時出示該傳票，以終止該法律程序。

4. 如需尋求法律意見，你應諮詢你的律師。

## Any person making a false certification/declaration or misrepresenting a material fact shall be guilty of an offence and liable to prosecution or disciplinary action where applicable.

1. DO NOT use this form, if your intention is to file a complaint, to make anenquiry, to apply for extension of time or to notify the completion of theprescribed works as required by the MWIS Notice. Please call the phonenumbers listed in paragraph 8 of the covering letter of the Penalty Notice orwrite to the Buildings Department separately.

2. Once the notice of dispute of liability is lodged, proceedings may be takenagainst you, and a summons issued in those proceedings may be served onyou in accordance with section 8 of the Magistrates Ordinance (Cap. 227).

3. After proceedings have been instituted but not less than 2 days (excludingany public holiday) before the day specified in the summons for yourappearance, you may pay the fixed penalty of $1,500 and a sum of $500 byway of costs with the production of the summons at any magistracy toterminate the proceedings.

4. If you require legal advice regarding the law, you should consult your lawyer.

甲. 個人資料 A. Personal Data

收集的目的1. 屋宇署會使用透過本表格所獲得的個人資料作下列用途：(a) 處理你在本表格中所呈交的文件的相關事務；(b) 處理有關上述罰款通知書的相關事務；及 (c) 方便屋宇署與你聯絡。

2. 你必須提供本表格所要求的個人資料 。假如你未能提供所需資料，可能導致處理你所呈交的文件時出現延誤，或甚至導致無法處理你的申請。

獲轉交資料的部門/人士3. 本署可能會向其他政府部門、決策局、機構或任何人士披露你透過本表格所提供的個人資料，以作上述第 1 段所列的用途。

索閱個人資料4. 根據《個人資料（私隱）條例》，你有權查閱及改正你所提交的個人資料。屋宇署有權就有關資料索閱的要求收取合理費用。如要求查閱及改正你的個人資料，請與屋宇署強制驗樓部聯絡。

Purposes of Collection 1. The personal data provided by means of this form will be used by the

Buildings Department for the following purposes:(a) activities relating to the processing of your submission in this form;(b) activities relating to the above penalty notice; and(c) facilitating communication between the Buildings Department and

yourself.

2. It is obligatory for you to provide the information as required in the form. Ifyou fail to provide the required data, delay may be caused in processing ofyour submission or even result in rejection of the application.

Classes of Transferees 3. The personal data you provided by means of this form may be disclosed to

other government departments, bureaux, organisations or any persons forthe purposes mentioned in paragraph 1 above.

Access to Personal Data 4. You have the right of access and correction with respect to the personal

data as provided under the Personal Data (Privacy) Ordinance. TheBuildings Department has the right to charge a reasonable fee for theprocessing of any data access request. Request for personal data accessand correction should be addressed to the Mandatory Building InspectionDivision of the Buildings Department.

乙. 填寫表格 B. Completion of Form

1. 請填妥表格載列所有有關的部分，並在表格上簽署。

2. 如對本表格有任何疑問，請與屋宇署強制驗樓部聯絡。

1. Please ensure that all relevant parts of the form are duly completed, andthe form is signed.

2. Enquiries regarding this form should be addressed to the MandatoryBuilding Inspection Division of the Buildings Department.

丙. 呈交方法 C. Submission Methods

1.郵寄/親身呈交 - 本表格連同有關文件應郵寄或親身呈交至:九龍油麻地海庭道11號西九龍政府合署北座屋宇署總部地下一般查詢及收件處

2.電子郵件傳送 - 透過電子郵件傳送本表格及有關文件（全部必須獲香港郵政署長發出的數碼證書認證，或根據《電子交易條例》認可的其他核證機關所發出的數碼證書認證）到屋宇署的電子收件處，電郵地址為 receipt@bd.gov.hk。

1. By Post / In Person - This form together with the relevant documents shall be posted to or submitted in person to :General Enquiry and Receipt Counter, G/F, Buildings Department Headquarters, North Tower, West Kowloon Government Offices, 11 Hoi Ting Road, Yau Ma Tei, Kowloon.

2. Through Email - Email this form together with the relevant documents, all with identity authenticated by a digital certificate issued by the Postmaster General or other certification authorities recognized under the Electronic Transactions Ordinance to the e-Counter of the Buildings Department at receipt@bd.gov.hk.

丁. 聯絡資料

屋宇署強制驗樓部地址：九龍油麻地海庭道11號西九龍政府合署北座屋宇署總部電話：2626 1616 (由 “1823” 接聽)傳真：3582 4227電郵：enquiry@bd.gov.hk

D. Contact Details

Mandatory Building Inspection Division, Buildings DepartmentAddress: Buildings Department Headquarters, North Tower, West Kowloon

Government Offices, 11 Hoi Ting Road, Yau Ma Tei, Kowloon Tel No.: 2626 1616 (handled by “1823”) Fax No.: 3582 4227Email: enquiry@bd.gov.hk

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