禁毒基金资助药物倚赖者治疗康复中心特别拨款计划申请表

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1、http://www.docin.com/sundae_meng本欄無須填寫ForOfficialUseOnly檔案編號ReferenceNo:禁毒基金资助药物倚赖者治疗康复中心特别拨款计划申请表BeatDrugsFundSpecialFundingSchemeforDrugDependentPersonsTreatmentandRehabilitationCentresApplicationForm申请机构必须参阅«禁毒基金资助药物倚赖者治疗康复中心特别拨款计划手册»（《手册》），并于《手册》指定的截止日期以前（如适用）送交香港金钟道66号金钟政府合署高座30楼禁毒基金会(由禁毒处转

2、交)。Thisformshouldbecompletedwithreferencetothe“ManualofBeatDrugsFundSpecialFundingSchemeforDrugDependentPersonsTreatmentandRehabilitationCentres”(theManual).ItshouldbereturnedtotheBeatDrugsFundAssociation,c/oNarcoticsDivision,30/F,HighBlock,QueenswayGovernmentOffices,66Queensway,HongKongbeforeth

3、edeadlinestipulatedintheManual(ifapplicable).(可用中文或英文填写。ThisformcanbecompletedinChineseorEnglish)I.计划名称ProjectName中文Chinese:__________________________________________________________英文English:___________________________________________________________II.申请机构Nameofapplicant中文Chinese:_____________

4、_____________________________________________英文English:___________________________________________________________地址Address:___________________________________________________________电话:传真:电邮地址:Tel.No._____________FaxNo.___________E-mailaddress___________负责人:职衔:ResponsiblePerson:________________

5、____PostTitle:16http://www.docin.com/sundae_meng可提供更详尽数据的人士(如与上述填报的负责人不同)Persontobecontactedforfurtherinformation(ifdifferentfromtheresponsibleperson)姓名:职衔:Name_______________________PostTitle__________________________地址:Address____________________________________________________________________

6、_________________________________________________________电邮地址E-mailaddress_____________________________________________电话:传真:TelNo._____________________Fax:________________________III.申请机构背景BackgroundInformationofApplicant(i)请注明是否根据下列条例注册:Pleasestatewhetheritisregisteredunder-□社团条例□公司条例theSociet

7、iesOrdinancetheCompaniesOrdinance□其他(请注明)Others(pleasespecify)_____________________________________注册年份(YearofRegistration:_______________________________)(ii)请注明是否《税务条例》第88条所指的慈善机构:Pleasestatewhethertheapplicantisacharitabl