postgraduate funded

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Please tick where applicable

Application for Campus Car Parking Permit for

Postgraduate Students

Class E – for Post-graduate Students attending UGC-funded courses on Campus

Class F – for Post-graduate Students attending Non-UGC-funded courses on Campus

Part A

(To be completed by the applicant)

I hereby apply the campus car parking permit for (tick where applicable): a. Full year (1 September – 31 August) b. c.

Half a year (1 September – end February)

Half a year (1 March – 31 August)

Serial No.

Valid Until

Permit No .

(for office use only)

Particulars of Vehicle a. Vehicle Registration Mark :

b If the applicant is not the registered owner, please state the name of spouse:

(Provide copy of relevant documents in support) c. Registration Expiry Date :

Driving Licence

a. Licence No. _________________________ b. Expiry Date _____________________________

Third Party Insurance a. Name of Company (not agent) ___________________________________________________________

b. Policy No. ____________________________ c. Expiry Date _____________________________

(Relevant documents for the aforesaid must be produced for verification)

I declare that, to the best of my knowledge, the particulars in this application are true and accurate and have not been disqualified in any previous applications.

I certify that I have read the notes / conditions overleaf / Campus Traffic and Parking Regulations of PolyU available on the FMO

Homepage prior to making the application and agree to abide by the Campus Traffic and Parking Regulations of PolyU.

_______________________ _________________________________________________

(Date) (Signature of Applicant)

_______________________ ______________________________________________ ___

(Name in BLOCK Letters) (PolyU Student Card No.)

________________________

(Course/ Programme Code)

_________________________________________________

(Department) (Tel. No. & e-mail address)

Part B

(To be completed by the appropriate Faculty/Dept/RO where and as appropriate)

* Recommended / Not recommended

_________________________________________

(Authorized Signature)

_________________________________________________

(Name in BLOCK Letters)

________________________________________

(Date)

Part C

(To be completed by the Security Checking Officer)

Personal particulars of the applicant were duly checked against the AS System and found correct.

__________________________________

(Signature)

____________________________________________

(Date)

Part D

l.

(To be completed by the Facilities Management Office)

Application and relevant documents checked : *Approved / Disapproved

___________________________________ ____________________________________________

(Authorized Signature) (Date)

2. Remarks : _________________________________________________________________________________

* Please delete as appropriate.

FMO CS26

(Revised July 2006)

NOTES

1. Only students attending UGC-funded Post-graduate Courses and Non-UGC-funded Post-graduate Courses on

Campus are eligible to apply for Class E & F Parking Permit respectively.

The restricted parking periods are :- Monday to Friday - 1700 - 0100 hrs

Saturday/Sunday/Public Holiday - 0700 - 0100 hrs

2. The following supporting documents are required to be submitted:- a) Photocopy of the Hong Kong Vehicle Registration Document (both sides) and marriage certificate if the b) c) d) e) f) vehicle is registered with the Government Transport Department in spouse’s name,

Photocopy of the Insurance Policy for the vehicle,

Photocopy of the applicant's driving licence,

Photocopy of the applicant's PolyU Student Card,

Photocopy of the tuition fees payment slip, and

A crossed cheque payable to "The Hong Kong Polytechnic University" with the amount as specified in the current Campus Traffic and Parking Regulations.

Failure to submit information mentioned above may delay in processing of application.

3. Whenever a vehicle is driven on PolyU Campus :- a) The driver must be holder of a valid driving licence. b) c)

The vehicle must be covered by valid vehicle licence and third party insurance.

The driver should be aware of and must observe the Campus Traffic and Parking Regulations of PolyU d) currently in force, and

The owner and / or driver must bear all liabilities for and indemnify PolyU against all damage to property and / or persons on campus which may be caused by his/her vehicle or by his/her control or management of his/her vehicle.

4. PolyU reserves the right to stick on “No Parking” or other notices onto the windscreen of; and to immobilize, move or relocate, without prejudice, all vehicles parked in contravention of any Campus Traffic and Parking

Regulations currently in force.

5.

6.

7.

8.

PolyU reserves the right to dispose of any abandoned vehicle, without prejudice, 3 months after abandonment, and to recover all costs incurred from the owner and / or the applicant if he/she is not the registered owner.

All vehicles on the campus are parked entirely at the owner’s risk. PolyU shall not be liable for any loss and / or damage to the vehicle, the driver, any passenger or any their property due to any causes whatsoever.

There is no guarantee of a carparking space for every permit holder at anytime on campus.

9.

The permit and transponder/tag card must be returned to the Campus Security Control Centre (room P111) or

Shroff Office at the entrance of carpark on transfer of car ownership or upon cessation of study of relevant post-graduate course/ programme.

The period of validity for the car parking Class E & F permit depends on the duration of corresponding specific period of study, or one year, whichever is less.

10. It is highly recommended to view the current Campus Traffic and Parking Regulations of PolyU for reference and compliance prior to submitting this application. Hard copy of these regulations are obtainable from

Campus Security Control Centre (room P111) and or retrieved from FMO Website : http://www.polyu.edu.hk/fmo/carpark.htm

11.

Please note that disciplinary action will be taken against all persons who knowingly and intentionally provide false statements or particulars for the purpose of obtaining a parking permit through this application.

12. The personal data you provide in this application and subsequently in the event of this application being either processed or given further effect will be used for considering this application only. Completion of all fields of this form is obligatory. Failure to complete one or more of the fields may affect further processing of this application. The personal data may be disclosed to other departments or units within the University only for the above purpose. You have the right to request for a copy of your personal data held by the University and to request for correction of any inaccuracy in the copy of personal data that is provided to you in accordance with the Personal Data (Privacy) Ordinance and subject to the data privacy policy and administrative requirements of the University. Enquiries concerning the personal data collected by means of this application should be addressed to the Facilities Management Office, The Hong Kong Polytechnic University or e-mail to fminfo@polyu.edu.hk

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