注意 Notes1.供已經啟動電子服務帳戶的供應商申請。For supplier who has activated the e-Services account.2.“請用正楷填寫申請表格，並在適當方格加內 ”。Please complete the application form in BLOCK LETTERS and place a“” mark where applicable.3.請把已填妥的表格交回電子採購試點計劃辦公室(傳真：28276646 或電郵：eppmgmtoff@ogcio.gov.hk)。Please return the completed form to E-Procurement Pilot Programme Office (FAX 28276646 or Email: eppmgmtoff@ogcio.gov.hk).4.如閣下於兩個工作天後仍無法收到我們的確認，請聯絡我們的服務 熱線 81070608。If you cannot receive our confirmation after 2 working days, please contact our hotline service at 81070608.甲組 - 公司資料 Section A - Company Information聯絡人姓名:Contact Person Name:└────────────┘供應商號碼 Supplier Code:└───────┘聯絡人電話號碼Contact Tel. No. └───────┘聯絡人傳真號碼Contact FAX No.: └───────┘公司名稱 (英文) Company Name (in English)└────────────────────────────┘乙組 - 申請事項Section B – Request Item□ 重發用戶編號 Reissue Master Account User ID□ 重發主用戶密碼 Reissue Master Account Password丙組 - 證明 Section C – CERTIFICATION注意 Notes本人明白倘若故意在本表格內提供任何虛假資料， 貴 署/部門可於供應商名單中移除本公司。I/We understand that any willful submission of false information by means of this form will result in our company be removed from the supplier list.授權簽署的申請公司代表人Signed for and on behalf of the applicant company(公司印鑑)(Space of Company Chop)簽署:Signature :___________________________姓名(正楷):Name in block letters:___________________________職銜:Designation :___________________________電話號碼:Tel. No.___________________________日期: Date :___________________________電子採購試點計劃辦公室專用 For e-Procurement Pilot Programme Office Use OnlyReceived by:Date:Approved by:Date:Inputted by:Date:Checked by:Date:
