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1、*根據屋宇署註冊記錄 in accordance with the registration record in Buildings Department ICUMW-F05(06/2015) 1/3簡化規定下的第 III 級別小型工程完工通知及證明書NOTICE AND CERTIFICATE OF COMPLETION OF CLASS III MINOR WORKS UNDER THE SIMPLIFIED REQUIREMENTS本表格及所有證明文件最遲須在小型工程項目完工日期後 14 天內呈交This form and all supporting document(s) must
2、be submitted within 14 days after the date of completion of the minor works item(s)請以正楷填寫表格，並在適當方格內加上號。填寫前，請仔細閱讀注意事項 。Please read the “Matters to Note”, complete the form in BLOCK LETTERS and tick in the appropriate box(es).致獨立審查組To Independent Checking Unit (“ICU”)MWHD 小型工程呈交編號Minor Works Submissio
3、n Number甲部Part A註冊承建商的委任通知 （由安排進行小型工程的人填寫）Notice of appointment of the registered contractor(To be completed by the person who arranged for the minor works to be carried out)1. 已完成小型工程的位置或地址Location or Address of the completed minor works（只在涉及豎設或改動招牌的工程並已獲分配呈交編號時適用）(Only applicable to works relating
4、 to the erection or alteration of signboard with Minor Works Submission Number assigned)徵收差餉及 /或地租通知書左上角的帳目編號The Account Number printed on the top left-hand corner of the Demand for Rates and/or Government Rent為方便確定工程位置或地址，可選擇提供Optional for easy identification of the location or address of the works
5、2. 已完成小型工程的詳情Details of the completed minor works另加附加頁Additional 張Page added小型工程項目Minor works Item描述Description各項小型工程項目及其描述（包括性質、位置和數量）必須提供。如空位不敷應用，請另加紙張填寫，附於本通知書內，並在每頁加簽、註明日期及 （如適用） 蓋上公司印鑑。Every minor works item and its description (including the nature, location and quantity) shall be provided. If
6、 space is insufficient, please attach additional sheet(s) which must be signed, dated and affixed with company seal (if applicable).3. 獲委任的註冊承建商的資料Particulars of the registered contractor appointed本人/我們已就本部所述工程委任下述的註冊承建商。I/we have appointed the registered contractor as below in respect of the works
7、detailed in this Part./ 註冊承建商中文名稱*Name in Chinese of the registered contractor* 註冊證明書編號*Certificate of Registration Number*註冊承建商英文名稱*Name in English of the registered contractor*ICU MW05運輸及房屋局常任秘書長(房屋) 辦公室Office of the Permanent Secretaryfor Transport and Housing (Housing)*根據屋宇署註冊記錄 in accordance wi
8、th the registration record in Buildings Department ICUMW-F05(06/2015) 2/34. 安排進行小型工程的人的詳情Particulars of the person who arranged for the minor works to be carried out中文名稱 Name in Chinese英文名稱 （如有，姓氏先行） Name in English (Surname first, if any香港身份證號碼 HKID Number 商業登記號碼 Business Registration Number 護照號碼 P
9、assport Number其他 （請註明） Others (Please specify) 護照簽發國家 （如適用） Country of issue of passport (If applicable)通訊地址 （如與甲 1 部份相同，則不用填寫）Correspondence Address (Not required to complete if same as Part A1)z 傳真號碼 Fax Number聯絡電話 Contact Number電郵地址 E-mail Address20安排進行小型工程的人 簽署 （如適用） 蓋上公司印鑑Signature of the perso
10、n who arranged for the minor works to be carried out & affixed with company seal (if applicable)日 月 年day month year乙部Part B註冊承建商的委任確認書、完工通知及證明書 （由已獲委任的註冊承建商填寫）Confirmation of appointment, notice and certificate of completion by the registered contractor (To be completed by the registered contractor
11、appointed)本人/我們 中文名稱 Name in ChineseI/We, 英文名稱 （如有，姓氏先行） Name in English (Surname first, if any)1.確認本人/我們已獲委任為甲部所述工程的註冊承建商；confirm that I/we have been appointed as the registered contractor of the works detailed in Part A ;2.確認甲部所述工程將於 20 展開並已於 20 完成；confirm that the works detailed in Part A had bee
12、n commenced on日 月 年Day month yearand completed on日 月 年Day month year;3.現呈交顯示有關的處所在緊接甲部所述的工程展開前及完工後的實際狀況的照片，及顯示已完成工程的圖則或工程描述；submit herewith the photographs showing the physical condition of the premises immediately before the commencement and after the completion of the works detailed in Part A, and
13、 the plans or description of works showing the works as completed;4.核證所有甲部所述的工程，已按照建築物條例的技術要求及於本部所呈交的圖則或工程描述進行， （如適用）而該些圖則均由，本人/我們製備和簽署； certify that all the works detailed in Part A, have been carried out in accordance with the technical requirements of the Buildings Ordinance and the plans or desc
14、ription of works submitted in this Part; and the said plans have been prepared and signed by me/us ;*根據屋宇署註冊記錄 in accordance with the registration record in Buildings Department ICUMW-F05(06/2015) 3/35.當本人屬於根據建築物（小型工程）規例第 11 條註冊的小型工程承建商【亦即 註冊小型工程承建商（個人） 】時，核證甲部所述工程已由本人親自進行；及where I am a contractor r
15、egistered under section 11 of the Building (Minor Works) Regulation also known as Registered Minor Works Contractor (Individual), certify that I have personally carried out the works detailed in Part A; and6.當 甲部 所 述 的 工 程 涉 及 豎 設 招 牌 時 ， 確 認 由 他 人 代 為 豎 設 招 牌 的 人 士 已 在 丙部 提 供 獨立審查組所 要 求 的 詳 情 。wher
16、e the works detailed in Part A involve the erection of a signboard, confirm that the person for whom the signboard is to be erected has provided the particulars of the person as required by the Independent Checking Unit in Part C.MWHD （只在早前已獲分配相關呈交編號的文件不能繼續處理時適用）(Only applicable where the previous submission with Minor Works Submission Number assign
