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1、奖券基金拨款申请表格(工程/家具及设备)/ApplicationFormforLotteriesFundGrant(Works/Furniture&Equipment)在填写此份表格前，请仔细参阅表格内附录5的指引及奖券基金手册PleasestudytheGuidanceNotesatAppendix5andtheLotteriesFundManualcarefullybeforeyoucompletetheform.一般数据表GeneralInformatiOnSheet1 .申请拨款的服务单位简介Briefdescriptionoftheapplyingserviceunit1.1 营办机
2、构：OperatingNGO:1.2 服务单位：Serviceunit:1.2.1 名称：Name:1.2.2 服务性质：Servicenature:1.2.3 地址：Address:1.2.4 电邮地址及传真号码：E-mailAddressandFaxNumber:1.2.5 通讯地址(如与上方不同)：CorrespondenceAddress(ifdifferentfromabove):1.2.6 联络人及电话号码：Contactperson&telephoneno.1.2.7 开办日期(月/年)：Commencementofoperation(month/year):1.2.8 开始接受
3、社会福利津贴日期(月/年)：Commencementofsubvention(month/year):2.申请拨款原因(综合描述是项申请的背景，原因及目的，而无需将每一项目类别给予理据)ReaSOnSfortheapplication(acomprehensivedescriptionofthebackground,reasonandpurposeofthisapplication,notjustificationsforeachrequesteditem)3.申请项目撮要SummaryOfIheapDlicaiion类别Caiegory申请款额元Am。Unlreuesled$附件(包括印文本
4、及计算机档案)(请在适当方格内加号)AUaChmenl(inhardandSoflCoDieS)(pleasetickwhereappropriate)3.1工程项目Worksitem()附录1Appendix23.2家具及设备Furniture&equipment()附录3Appendix13.3其他，如购买车辆(请注明)Others,suchaspurchaseof(pleasespecify)vehicle()附录3I-IAppendixI1总款额:Total:()4. 项目时间表ProjeCtTimetable就工程项目ForWorksProject拨款后一月Months after
5、grant approval或/or于 年第 季内in Q/(Quarter/ Year)聘请顾问后一月Months after hiring of consultant或/or于 年第 季内in Q/(Quarter/ Year)41提交聘请顾问文件以供审批SubmissionofdocumentsforhiringofConsultantforvetting提交聘请总承建商文件以供审批SubmissionofdocumentforhiringofMainContractorforvetting43实际竣工Practical completion of works44提交结算项目账目Subm
6、ission of final account聘请总承建商后一月Monthsafterawardofmaincontract或/or于年第季内inQ/(Quarter/Year)实际完工后一月Monthsafterpracticalcompletion或/or于年第季内(II)就采购家具及设备项目For Project on Purchase of Furniture & Equipment45 落单Placement of Order for Purchase4.6 送货Delivery4.7 提交结算项目账目Submission of final payment claim拨款后一月Mon
7、ths after grant approval 或/or于 年第 季内in Q/(Quarter/ Year)落单后一月-Months after placing order或/or于 年第 季内in Q/(Quarter/ Year)送货后一月Months after deliverj,或/or于 年第 季内in Q/(Quarter/ Year)(HI)就其他项目For Other Projects4.8 拨款后展开与项目有关的工作(请提供详 情)Commencement of work related to the PrQjeCt after grant allocation (ple
8、ase provide details) -拨款后一月Months after grant approval或/or于 年第 季内in Q/(Quarter/ Year)4.9 项目进行中(请提供详情)Project in-progress (please provide details) -展开与项目有关的工作后_月 Months after commencement ofwork related to the project或/or于 年第 季内in Q/(Quarter/ Year)I如有需要,可另加补充纸张Supplementary sheets may be added4.10 提交
9、结算项盲账目Submission of final payment claim项目完成后一月Months after completion of project 或/or于 年第 季内in Q/(Quarter/ Year)inQ/(Quarter/Year)5. 声明DeCIaratiOn我谨代表（申请机构）在此声明，申请机构就是次申请之项目并没有在最近5年向任何资助计划申请或没有从任何资助计划获批资助。我承诺日后任何有关是次申请的数据的改变（例如于提交是此申请后获其他资助计划拨款资助同一申请项目），申请机构尽快通知社会福利署的奖券基金计划组。1, onbehalfof(applicanto
10、rganisation),herebydeclarethattheapplicantorganisationisNOTapplyingfororhasNOTbeengrantedanyfinancialsupportunderanyotherfundingschemesfortheitemsunderapplicationinthelastfiveyears.Iundertakethattheapplicantorganisationwillinformanychangeininformationinrespectofitsapplication(e.g.subsequentapprovalo
11、ffundsunderotherfundingschemeforthesameprojectunderapplicationaftertheapplicationissubmitted)totheLotteriesFundProjectsSectionoftheSocialWelfareDepartmentassoonaspossible.我在填写此份表格时己经仔细参阅表格内附录5的指引及奖券基金手册。同时，我亦已附上所有需要的有关文件以供审阅。IhavereadtheGuidanceNotesatAppendix5andtheLotteriesFundManualcarefullybefor
12、ecompletingthisform.Ihavealsoenclosedallthesupportingdocumentsrequired.负责职员：Preparedby（签署）（Signature）姓名：Name职位：Post电话号码：TelephoneNo.日期：Date警告Warning任何虚假声明可导致批款协议被中止、机构需退还已发放之资助及刑事检控的可能。Anyfalsedeclarationmayleadtoterminationofthefundingagreement,refundofanyfundsdisbursed,andthePoSSibiIityOfCriminalcharges.
