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[s41(1)]

Broadcasting Ordinance

(Cap. 562)

Statutory Declaration Form on Persons regarded as Fit and Proper

for a Domestic Free/Domestic Pay/Non-domestic/Other Licensable *

Television Programme Service Licensee

Notes:

  1. This declaration form is issued by the Communications Authority (CA) under section 41(1) of the Broadcasting Ordinance (Cap. 562) for the purposes of the submission of information by a domestic free / domestic pay / non-domestic / other licensable* television programme service licensee on persons regarded as fit and proper. Please read carefully the “Guidance Note for licensees and companies seeking to be licensees on information to be provided in relation to restrictions on persons not regarded as fit and proper under section 21 of the Broadcasting Ordinance (Cap. 562)”before completing this form.
  1. The terms used herein, where applicable, have the same meanings as in the Broadcasting Ordinance.
  1. Please include Chinese names where appropriate.
  1. Please attach additional sheets if required.

* A licensee providing the type A other licensable television programme service mentioned in Schedule 4 to the Broadcasting (Licence Fees) Regulation.

OFCA SF0015 (12) (Rev.4/2012)

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IN THE MATTER of Section 21(2) of the Broadcasting Ordinance (Cap. 562)
and
IN THE MATTER of the Oaths and Declarations Ordinance (Cap. 11)
STATUTORY DECLARATION

I, (Name) [HKID No.: XXXXXX] of (Address) , being (Company Secretary/Director/Principal Officer) of (Licensee) [Company No.: XXXX] (“the Licensee”), do solemnly and sincerely declare that –

The Licensee and all persons exercising control of the Licensee whose names are listed in Schedule [ 1 ] attached hereto (each a “relevant person”) are fit and proper persons after careful inquiry and having regard to –

(1) / the business record of the Licensee and each relevant person;
(2) / the record of the Licensee and each relevant person in situations requiring trust and candour;
(3) / the criminal record in Hong Kong of the Licensee and each relevant person in respect of offences under the laws of Hong Kong involving bribery, false accounting, corruption or dishonesty; and
(4) / the criminal record in places outside Hong Kong of the Licensee and each relevant person in respect of conduct which, if done in Hong Kong, would constitute or form part of the criminal record in Hong Kong of the Licensee and each relevant person as mentioned in (3).

Information concerning the business record(s) referred to in paragraph (1) above of the Licensee and each relevant person is attached at Schedule [2] hereto.

Information and record(s) of the Licensee and each relevant person in situations requiring trust and candour referred to in paragraph (2) above is attached at Schedule [3] hereto.

Information and criminal record(s) referred to in paragraph (3) above of the Licensee and each relevant person is attached at Schedule [4] hereto.

Information and criminal record(s) referred to in paragraph (4) above of the Licensee and each relevant person is attached at Schedule [5] hereto.

AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Ordinance (Cap. 11).

(Signed)

DECLARED at / [please insert address] / in Hong Kong this ______day of ______.
Before me,
[Signature and designation, i.e. Justice of the Peace/Notary Public/Commissioner for Oaths]

1

Schedule [1]

All Persons (including individuals and corporations) exercising control of

(Licensee) as at (Date)

(1)All directors or principal officers of the Licensee
Name / Office Held
(2)All beneficial owners of more than 15% of the voting shares in the Licensee
(3) All voting controllers of more than 15% of voting shares in the Licensee
(4) All persons who have the power, by virtue of any powers conferred by the memorandum or articles of association or other instrument regulating the Licensee or any other corporation, to ensure that the affairs of the Licensee are conducted in accordance with their wishes

Schedule [2]

Information concerning business record(s) referred to in paragraph (1) in
the Declarationof the Licensee and each relevant person
in Hong Kong or elsewhere

For the Licensee and each relevant person, please provide informationconcerning the business record(s) as at the date of the Declarationincluding, but not limited to the followings -

Name of the Licensee / each relevant person : ______

a. Is the person a director or principal officer of any corporation or a person responsible for the management of any Undertaking other than the Licensee (whether on his own or jointly with any others)?


 / No
Yes (Please specify)______
______
______
______
______

b. Does the person hold or is entitled to exercise (i) any beneficial interest in more than 50% of the allotted shares in, (ii) any right to share in more than 50% of the capital of, or (iii) any right to share in more than 50% of the profits of, an Undertakingother than the Licensee?


 / No
Yes (Please specify)______
______
______
______
______

c.Does the person have any obligation or liability to contribute to more than 50% of the losses, debts or expenses of, an Undertaking other than the Licensee?


 / No
Yes (Please specify)______
______
______
______
______

d.Is the person a voting controller of more than 50% of the voting shares in any Undertaking other than the Licensee?


 / No
Yes (Please specify)______
______
______
______
______

e.Does the person have the power, by virtue of any powers conferred by the memorandum or articles of association or other instrument regulating any Undertaking other than the Licensee, to ensure that the affairs of the Undertaking are conducted in accordance with his wishes?


 / No
Yes (Please specify)______
______
______
______
______

f.Does the person have the right to (i) remove a majority of the directors or office holders of, or (ii) exercise a veto right over the operation or financial policies of, any Undertakingother than the Licensee?


 / No
Yes (Please specify)______
______
______
______
______

g.Is, or has the person been, subject to liquidation, bankruptcy or other similar proceedings/orders?


 / No
Yes (Please specify)______
______
______
______
______

h.Is there any other relevant information in respect of the business record of the person which may be useful for assessingwhether the person is a fit and proper person?


 / No
Yes (Please specify)______
______
______
______
______

 Please tick as appropriate

Schedule [3]

Information and record(s) concerningthe Licensee and each relevant person in situations requiring trust and candour in Hong Kong or elsewhere referred to
in paragraph (2) in the Declaration

For the Licensee and each relevant person, please provide information and record(s) concerning the person in situationswhere the person may have failed to act with trust and candour including, but not limited to the followings -

Name of the Licensee / each relevant person : ______

a.Is, or has the person been censured, disciplined or disqualified by any professional or regulatory body in relation to any trade, business or profession in Hong Kong or elsewhere?


 / No
Yes (Please specify)______
______
______
______
______

b.Is, or has the person been disqualified by a court of competent jurisdiction from being a director, etc. in Hong Kong or elsewhere?


 / No
Yes (Please specify)______
______
______
______
______

c.Is there any other relevant information in respect of the person’s record in situations requiring trust and candour which maybe useful for assessingwhether the person is a fit and proper person?


 / No
Yes (Please specify)______
______
______
______
______

 Please tick as appropriate

Schedule [4]

Information and criminal record(s) referred to in paragraph (3) in the Declaration
of the Licensee and each relevant person in Hong Kong

Schedule [5]

Information and criminal record(s) referred to in paragraph (4) in the Declaration
of the Licensee and each relevant person in places outside Hong Kong