表 格 FORM:LE3
申请编号: Application No.:
香港中医药管委员会
The Chinese Medicine Council of Hong Kong
2012中医执业资格试第II部分床考试报名表
Enrolment Form for Sitting the 2012 Chinese Medicine Practitioners Licensing Examination – Part II Clinical Examination
香港法第549章《中医药条》
Chinese Medicine Ordinance (Cap. 549)
此报名表只适用於已通过第 I 部分笔试的申请人.
This enrolment form is only for the applicants who have passed the Part I - Written Examination. 申请人必须把已填妥的报名表,於20123月30日(星期五)或之前,同所需费用,以挂号邮递方式 或亲身送达香港中医药管委员会秘书处.逾期报名,恕接受.申请人亦可以缴费1缴付所需费 用.如以挂号邮递方式递交报名表,则以邮戳日期为准.
Applicants must submit the enrolment form together with the prescribed fees to the Secretariat of the Chinese Medicine Council of Hong Kong by registered post or in person on or before 30 March 2012 (Friday). Late enrolments will not be accepted. Applicants may pay the prescribed fees by using Payment by Phone Service (PPS)1. For enrolments submitted by post, the post mark will be taken as the submission date.
A部 付款方法 Section A Payment Method
□
支票
Cheque
□
缴费
PPS
请注明使用缴费的缴费日期:
Please fill in the PPS Payment Date:
.
B部 个人资 (请以正楷书写) Section B Personal Particulars (Please write in BLOCK LETTERS)
中文姓名 Name in Chinese 香港身份证号码
Hong Kong Identity Card No.
(如适用者) (If applicable)
英文姓名(先写姓氏) Name in English (Surname first)
-
护照/身份证明文件号码
Passport/ Identification Document No. (本供没有香港身份证的申请人填写)
(for applicants without Hong Kong Identity Card)
护照/身份证明文件种
Passport/ Identification Document Type (本供没有香港身份证的申请人填写)
(for applicants without Hong Kong Identity Card)
签发机关
Issuing Authority
请在适当方格内加上「 」号. Please " " in the appropriate box. 附注(1): 有关缴费的缴费详情,请阅考生手册. Note(1): Regarding the payment by using PPS, please refer to the Candidates' Handbook for details. 附注(2): 中医执业资格试只备有中文试卷. Note(2): The Licensing Examination Papers are printed in Chinese only.
LE3
1

下一页