1、Office of the Permanent Secretaryfor Transport and Housing (Housing)運輸及房屋局常任秘書長(房屋)辦公室ICU MW09 簡化規定下已獲委任的建築專業人士提名另一位建築專業人士在暫時不能行事期間代為行事的通知書NOTICE OF NOMINATION BY BUILDING PROFESSIONAL APPOINTED OF ANOTHER BUILDING PROFESSIONAL TO ACT IN HIS PLACE FOR THE PERIOD OF TEMPORARY INABILITY TO ACT UNDER T2、HE SIMPLIFIED REQUIREMENTS本表格須在有關提名的日期後7天內呈交This form must be submitted within 7 days after the date of the nomination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”)3、甲部Part A提名人的提名通知及確認書 【由提名人（即提名另一人代為行事的已獲委任的建築專業人士）填寫】Notice of nomination and confirmation by the nominatorTo be completed by the nominator (the building professional appointed who nominates another person to act in his place)MWHD小型工程呈交編號Minor Works Submission Number必須填寫 MUST COMPLETE注意：如多於一個小型工程呈交編4、號，請填寫於丙部內。Notes : If there is more than 1 minor works submission numbers, please fill in Part C.本人為上述及丙部內所有呈交編號呈交文件內的已獲委任的中文姓名*Name in Chinese*I, am the英文姓名*Name in English*認可人士/房屋署總專業人士+authorized person/Chief Professional+ in Housing Department/註冊檢驗人員registered inspector，註冊結構工程師/房屋署總結構工程師+register5、ed structural engineer/Chief Structural Engineer+ in Housing Department，註冊岩土工程師/房屋署總岩土工程師+registered geotechnical engineer/ Chief Geotechnical Engineer+ in Housing Department，本人現作出通知，確認已提名下述的建築專業人士在本人因appointed in the above mentioned submission number and all submission numbers listed in Part C. I h6、ereby notify and confirm that I have nominated the building professional as below to act in my place for the period of my患病，即由20至20或另行通知為止，illnessas from日 day月 month年yearto日 day月month年yearoruntil further notice暫時離開香港期間temporary absence from Hong Kong就上述及丙部內所有呈交編號呈交文件內的小型工程代本人行事。in respect of the min7、or works detailed in the submission with the above mentioned submission number and all submission numbers listed in Part C. / 註冊證明書編號*#Certificate oqqqqf Registration Number*# 傳真號碼* Fax Number*註冊屆滿日期*#Date of expiry of registration*# 20 20 日 月 年Day month year提名人 簽署*Signatur*e of the nominator 日 月年Da8、y month year乙部Part B被提名人的確認書（由被提名的建築專業人士填寫）Confirmation of nomination by the nominee (To be completed by the building professional nominated)本人中文名稱 Name in ChineseI,英文姓名*Name in English*現確認接受甲部所述的提名，就上述及丙部內所有呈交編號呈交文件內的小型工程在甲部所述期間代甲部所述的提名人行事。confirm my acceptance of the nomination detailed in Part A 9、and that I will act in the place of the nominator for the period detailed in Part A in respect of the minor works detailed in the submission with the above mentioned submission number and all submission numbers listed in Part C. / 註冊證明書編號*# Certificate of Registration Number*# 傳真號碼* Fax Number*註冊屆滿日10、期*#Date of expiry of registration*# 20 20 日 月 年Day month year被提名人 簽署*Signature* of the nominee 日 月年Day month year+ For explanatory note on signing capacity, refer to Appendix B of ICUI 04. 刪去不適用者 Delete as appropriate# 如適用 if applicable丙部Part C小型工程呈交編號（如適用時由提名人填寫）Minor works submission numbers (To b11、e completed by the nominator if applicable)MWHDMWHDMWHDMWHDMWHDMWHDMWHDMWHDMWHDMWHDMWHDMWHD如空位不敷應用，請另加紙張填寫，附於本通知書內，並在每頁加簽及註明日期。 If space is insufficient, please attach additional sheet(s) which must be signed and dated. * 根據屋宇署註冊記錄in accordance with the registration record in Buildings Department IC12、UMW-F09(06/2015) 2/2 ICU MW09 注意事項ICU MW09 Matters to Note甲.個人資料A.PERSONAL DATA收集的目的Purposes of Collection1.獨立審查組會使用透過本表格所獲得的個人資料作下列用途：1.The personal data provided by means of this form will be used by the Independent Checking Unit for the following purposes:(a)辦理有關處理你在本表格中所呈交的文件的事務；(a)activities re13、lating to the processing of your submission in this form;(b)辦理有關小型工程的事務；及(b)activities relating to minor works matters; and(c)方便獨立審查組與你聯絡。(c)facilitating communication between the Independent Checking Unit and yourself.2.你必須提供本表格所要求的個人資料。假如你未能提供所需資料，可能導致處理你所呈交的文件時出現延誤。2.It is obligatory for you to p14、rovide the personal data as required by this form. If you fail to provide the required data, delay may be caused in processing of your submission.獲轉交資料的部門/人士Classes of Transferees3.你透過本表格所提供的個人資料會向下列人士/部門公開：3.The personal data you provide by means of this form may be disclosed to:(a)其他政府部門、決策局及有關機構，15、以作上述第1段所列的用途；及(a)other Government departments, bureaux & relevant organizations for the purposes mentioned in paragraph 1 above; and(b)任何人士，以作上述第1段(b)項所列的用途。(b)any person for the purpose mentioned in paragraph 1(b) above.索閱個人資料Access to Personal Data4.根據個人資料（私隱）條例第18及22條及附表1第6條，你有權索閱及修正你的個人資料。你的索閱權包16、括獲取本表格所提供的個人資料副本一份。4.You have a right of access and correction with respect to 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 this f17、orm.乙.填寫表格B.COMPLETION OF FORM1.請填妥表格載列所有有關的部分，並在表格上簽署。1.Please ensure that all relevant parts of the form are duly completed, and the form is signed.2.所提供的資料如有不全或錯誤，獨立審查組將不能處理呈交的文件。2.If incomplete or erroneous information is provided in the form, the Independent Checking Unit may not be able to pro18、cess the submission.3.就有關此通知的任何失實核證或聲明可引致法律行動。3.Any false certification or declaration in connection with this Notice may be subject to legal action.丙.呈交方法C.SUBMISSION METHODS1.郵寄呈交 - 本表格連同有關文件應郵寄至九龍黃大仙龍翔道138號龍翔辦公大樓8樓獨立審查組。1.By Post - This form together with the relevant documents shall be posted to19、 Independent Checking Unit, 8/F, Lung Cheung Office Block, 138 Lung Cheung Road, Wong Tai Sin, Kowloon.2.親身呈交 - 親往九龍黃大仙龍翔道138號龍翔辦公大樓8樓獨立審查組，於收發處櫃位遞交本表格及有關文件。2.In Person - In person at Independent Checking Unit, 8/F, Lung Cheung Office Block, 138 Lung Cheung Road, Wong Tai Sin, Kowloon. Produce and submit this form together with the relevant documents at the Receipt & Dispatch counter.