Application for Campus Car Parking Permit (Initial)
Please tick where applicable
Serial No.
Valid Until
Class A – Full time staff
Class B - Contractors
Class C – PTE visiting academic staff
Class D – PTD visiting academic staff
Permit No .
(for office use only)
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.
Half a year (1 September – end February)
c.
Half a year (1 March – 31 August)
Particulars of Vehicle
a. Vehicle registration mark
b. If the applicant is not the registered owner, please state the
name of spouse:
(and provide copy of marriage certificate)
c. Licence 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)
(If the applicant is not a PolyU full-time staff,
please state name of company, business address
telephone number below).
I certify that the above particulars are correct; that I have read
the notes/conditions overleaf and agree to abide by the Campus and
Traffic and Parking Regulations of PolyU.
___________________________________________________
(Signature of Applicant)
___________________________
(Name in BLOCK Letters)
____________________
(PolyU Staff Card No.)
___________________________ ____________________
(Date)
(Department)
(Tel. No. & E-mail Address)
__________________________________________________________________________________________________
Part B (To be completed by the appropriate Faculty / Dept / Unit / Office)
a.
* Recommended / Not recommended. (* Delete where applicable)
b.
The applicant is a member of * part-time evening academic staff / part-time day academic staff teaching / working on the
campus or other as shown below : ( Please note that this Part B is not applicable to full-time staff, therefore
endorsement from HoD is not required) (*Delete where applicable)
_____________________________________________________________________________________________
_________________________________________
(Authorized Signature)
(Name in BLOCK Letters)
HoD _____________________________________
(Date)
FMO CS21
(January 2007)
Part C
(To be completed by the Security Checking Officer)
Personal particulars of the applicant were duly checked against the HRO System and found correct.
__________________________________
(Signature)
_______________________
(Date)
___________________________________________________________________________________________
Part D (To be completed by the Facilities Management Office)
l.
a.
Application and relevant documents checked
Approved / Disapproved
___________________________________
(Authorized Signature)
b.
Reason : (if disapproved )
_______________________
(Date)
________________________________________________________
__________________________________________________________________________________
2.
Remarks :
___________________________________________________________________________
NOTES
1.
Class B permit may, on the authorization of the Security Officer or his delegate, be issued to staff or designated users of
Non-PolyU entities normally working on campus such as staff of stationed bank, canteen operators, contracted suppliers,
etc. (Ref: Para, 27(iii) of the current Campus Traffic and Parking Regulations), Class C & D Permits are issued to eligible
part-time staff as stipulated in paras 27 (iv) & (v) of the current Campus Traffic & Parking Regulations.
2.
Whenever a vehicle is driven on PolyU Campus :a) The driver must be holder of a valid driving licence,
b) The vehicle must be covered by valid vehicle licence and third party insurance,
c) The driver should be aware of and must observe the Campus Traffic and Parking Regulations of PolyU currently in force,
d) 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.
3.
The following supporting documents are required to be submitted:a) Photocopy of the Hong Kong Vehicle Registration Document (front & back),
b) Photocopy of the Insurance Policy for the vehicle,
c) Photocopy of the applicant's driving licence,
d) Photocopy of the applicant's PolyU Staff Card, and
e) 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.
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 and Parking Regulations currently in force.
5.
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.
6.
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.
7.
There is no guarantee of a carparking space for every permit holder.
8.
The permit and transponder/proximity card must be returned to the Facilities Management Office in room P111 on transfer
of car ownership or upon departure from PolyU.
9
It is highly recommended to view the current Campus Traffic and Parking Regulations of PolyU for reference and
compliance prior to submitting this application. Hardcopy of these regulations can be obtained from the Facilities
Management Office in room
P111 at telephone no. 2766 7l77, and or retrieved from FMO Website
http://www.polyu.edu.hk/fmo/carpark.htm.
10.
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.