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1、 LCS 770 (Revised 9/2016) 申請編號 Application No.: _ 照片複製照片複製/閉架參考資料閉架參考資料影印申請表格影印申請表格 Application for Reproduction of Photographs / Photocopy of Closed Stack Reference Materials 申請人： Applicant 公司/機構名稱 (如適用)： Company/Organization (if applicable) 電話號碼： 傳真號碼： 電郵: Telephone No. Fax No. E-mail 地址： Address申
2、請申請複製複製/影印項目影印項目 Details of Requested Items # (如有需要如有需要，請另備附頁，請另備附頁 If necessary, please use additional papers) 參考參考編號編號 / 索書索書號號 Ref. No. / Call No. 照片照片 /閉架閉架參考資料參考資料* 說明說明 Brief Description of Photographs / Closed Stack Reference Materials * 照片數碼檔案照片數碼檔案 Softcopy of Photograph 如適用，請填上 Please mark
3、 if appropriate閉架閉架參考資料參考資料影印本頁數影印本頁數 No. of Photocopies of Closed Stack Reference Materials Requested A4 尺寸尺寸 Size A3 尺寸尺寸 Size # 有關服務收費，請參閱背頁的申請須知 Please refer to the Notes to Applicant overleaf for the service fees 聲明聲明 Declaration (警告：申請人如提出虛假聲明，須負上侵犯版權的法律責任。警告：申請人如提出虛假聲明，須負上侵犯版權的法律責任。 ) (Warnin
4、g: The applicant who makes a false declaration is liable for infringement of copyright.) 1. 我 / 我們使用複製照片 / 閉架參考資料影印本 * 作為下述用途： I / We declare that the reproduced photograph(s) and photocopy/photocopies of closed stack reference materials * will be used for the following purpose(s)： _ 如作出版/刊載用途者，請提供以
5、下資料： Please provide further information if the requested items are for publishing purposes： 刊物名稱： Publication Title： 性質 Nature： 出售/商業for sale/commerce 慈善for charity 免費派送free distribution 其他 others: _ 類型 Type： 書籍 book 期刊/雜誌 periodical/magazine 小冊子 pamphlet 展覽 exhibition/display 網頁 webpage 錄影帶/光碟 vide
6、o tape/CD-Rom 其他 others: _ * 2. 根據版權條例(香港法例第 528 章)，本人明白閉架參考資料影印本只可作研究及私人研習之用。在影印前，本人須根據法例作出聲明/承諾。 According to Copyright Ordinance (Cap.528 HK), I understand that closed stack reference materials could be photocopied for research and private study only. A separate statutory declaration is required
7、should I request for photocopying. 日期 Date： 申請人簽署 Signature of applicant： (簽署前，請先細閱背頁的申請須知申請須知。) (Please read the Notes to Applicant overleaf before signing) * 請刪去不適用者 Delete where inappropriate 本辦事處專用本辦事處專用 For official use only Approval Fees Progress * Approved / Not Approved Signature:_ Post:_ Da
8、te: _ HK$ _By cash / cheque* Payment received date: _ M.R. No.: _ Items ready date: _ Items collection date: _ Handled by: _ Post:_ 複製照片及閉架參考資料影印本 reproduced photograph(s)andphotocopy/ photocopies of closed stack reference materials列印 Print重設 ResetLCS 770 (Revised 9/2016) 申請申請須知須知 Notes to Applicant
9、 複製複製/影印服務收費表影印服務收費表 Fees of Reproduction / Photocopying Services 申請及使用條款申請及使用條款 Terms and Conditions of Application and Use 項目項目 Item 收費收費 (港幣港幣) Fee (HKD) 1. 如欲申請古物古蹟辦事處的照片複製或閉架參考資料影印服務，申請人須填妥並簽署 此申請表格，親身遞交或郵寄至九龍尖沙咀九龍公園香港文物探知館參考圖書館 。 此外，申請人亦可以電郵 (amolcsd.gov.hk) 或傳真 (2377 9792) 的方式遞交。 Please fill
10、in and sign this application form for reproduction / photocopying services of the photography / closed stack reference materials provided by the Antiquities and Monuments Office. Duly completed application form can be submitted in person or by post to the Reference Library of the Hong Kong Heritage
11、Discovery Centre at the Kowloon Park in Tsim Sha Tsui, Kowloon. Application by email (amolcsd.gov.hk) or by fax (2377 9792) is also accepted. 2. 由接獲申請表格及所需補充資料(如有)的日期起計，一般照片複製工作會於十四個工 作天內完成；一般閉架參考資料影印工作會於四個工作天內完成。 Application for reproduction of photographs would normally be completed within 14 work
12、ing days while photocopying of closed stack reference materials would normally be completed within 4 working days to process upon receipt of the form and the supplementary information, if any. 3. 請與參考圖書館職員核實應繳費用，並請親身前往參考圖書館辦理繳費及領取複製/ 影印項目的手續。 Please check with the Reference Library Officer for the e
13、xact amount of payment. Payment should be made and reproduced/ photocopied item(s) should be collected in person at the Reference Library. 4. 若申請人於訂購後三個月內仍未提取已訂購之複製/影印項目，本辦事處有權棄置該批 複製/影印項目，所有已支付的費用將不獲發還。 No refund of the fees already paid would be made if the reproduced/ photocopied item(s) is/are n
14、ot collected within three months from ordering. The Office reserves the right to dispose such item(s) after the three months period. 5. 古物古蹟辦事處執行秘書有權在其認為適當的情況下，拒絕提供有關的複製照片/閉架 參考資料影印本。 The Executive Secretary of the Antiquities and Monuments Office reserves the right to refuse supply of reproduced photograph(s) or photocopy/photocopies of closed stack reference materials as he/she sees fit. 6. 每次申請只可使用複製照片一次一次。古物古蹟辦事處保留若干照片之使用權及刊載權。 因此，申請人應先與本辦事處磋商以確定是否可使用其所需項目。若其申請之用途抵
