Request Form for Printed Health Education Materials
Central Health Education Unit, Department of Health
衞生署中央健康教育組健康教育印刷教材索取表格

Please tick「☑」in the appropriate box to indicate your choice of location for collection of printed materials and return the completed form by post or fax to one of the following Central Health Education Unit (CHEU) offices : -

請在適當空格內加上「☑」以選擇領取印刷教材的地點，並將填妥的表格以郵寄或傳真方式交回下列其中一個辦事處 : -
  Offices Address Enquiry No. Fax No.
  辦事處 地址 查詢電話 傳真號碼
☐ CHEU - Wanchai Office 7/F, Southorn Centre,
130 Hennessy Road, Wanchai, H.K.		 2572 1476 2591 6127
  中央健康教育組 - 灣仔辦事處 香港灣仔軒尼詩道130號修頓中心7樓    
 
☐ CHEU - Tsuen Wan Office 13/F, Tsuen Wan Government Office,
38 Sai Lau Kok Road, Tsuen Wan, N.T.		 2417 6505 2498 3520
  中央健康教育組 - 荃灣辦事處 新界荃灣西樓角路38號
荃灣政府合署13樓		    
We will inform you of the date of collection upon receipt of your request form.
我們收到你的索取表格後,會通知你到取日期。

Requesting Party 索取人

Name 姓名 ________________________________   Fax No. 傳真 _____________________________
*Organization 所屬機構 ______________________   Signature 簽署 ____________________________
Contact No. 電話 ___________________________   Date 日期 ________________________________
Remarks 備註 ________________________________________________________________________________

*Fill in when appropriate 適用時填寫

Note : The information contained in this form will only be used for processing the request for printed materials. The Department of Health reserves the right to decide on the quantity of materials provided.
註 ：本表格內的資料只會用作處理索取印刷教材申請。衞生署保留決定所提供教材數量的權利。
Please indicate in the appropriate box / boxes the quantity of printed materials required : -
請在適當空格內填寫所需印刷教材的數量 : -




Date of Collection 到取日期

_______________________________________

Officer's Signature (Liaison) 職員簽署 (聯絡)

_______________________________________

Date 日期

_______________________________________

Officer's Signature (Collection) 職員簽署 (取貨)

_______________________________________

Date 日期

_______________________________________
   Name 姓名

_______________________________________

*Organization 所屬機構

_______________________________________

Signature 簽署

_______________________________________

Date 日期

_______________________________________


* Fill in when appropriate
適用時填寫






Notice of Collection of Personal Data 收集個人資料公告
  1. Purpose of Collection 收集資料的目的

    1. The personal data provided will be used by the Department of Health (“DH”) for processing your application.

      衞生署會使用收集所得的個人資料處理你的申請。

    2. The personal data collected will be retained no longer than necessary for the fulfillment of the above purpose.

      收集所得的個人資料，其保留時間不會超過貫徹上述目的所需的時間。

    3. The provision of personal data is voluntary. If you do not provide sufficient information, we may not be able to provide the requested service to you.

      提供個人資料，純屬自願。如你未能提供足夠資料，我們可能無法處理你要求提供的服務。


  2. Classes of Transferees 資料承轉人類別

    The personal data you provide are mainly for use within DH but they may also be disclosed to other Government bureaux/departments or relevant parties for the purposes mentioned in Section 1 above, if required. Apart from this, the data may only be disclosed to parties where you have given consent to such disclosure or where such disclosure is allowed under the Personal Data (Privacy) Ordinance.

    你所提供的個人資料，主要供本署內部使用，但如有需要，也可能為本文第1部分所述目的，向其他政府決策局／部門或有關各方披露。此外，只有在你同意作出該項披露或該項披露是《個人資料﹝私隱﹞條例》所允許的情況下，本署才會向有關方面披露有關資料。


  3. Access to Personal Data 查閱個人資料

    You have the right of access and correction with respect to your personal data as provided for in Sections 18 and 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance. Your right of access includes the right to obtain a copy of your personal data provided by you during the occasions as mentioned in Section 1 above. A fee may be imposed for complying with a data access request.

    根據《個人資料﹝私隱﹞條例》第18及第22條，以及附表1第6原則的規定，你有權查閱和改正你的個人資料。你的查閱權包括有權索取你在本文第1部分所述情況下所提供個人資料的複本一份。為依從查閱資料要求，可能會徵收費用。


  4. Enquiries 查詢
    Enquiries concerning personal data provided, including the making of access and corrections, should be addressed to Senior Executive Officer (Health Promotion), Central Health Education Unit, Department of Health, 7/F, Southorn Centre, 130 Hennessy Road, Wan Chai, Hong Kong (Tel No: 2835 1821).

    有關所提供個人資料的查詢﹝包括查閱和改正資料﹞，應送交：香港灣仔軒尼詩道130號修頓中心7字樓衞生署中央健康教育組高級行政主任﹝健康促進﹞(電話：2835 1821)。