Application Ref (For official use):

The Government of the Hong Kong Special Administrative Region

Emission Control of Non-road Mobile Machinery (“NRMM”)

Application for Exemption of NRMM Not Meeting

Prescribed Emission Standard for Temporary Use

Please read the Procedures for Application for Approval, Exemption or Modification of Non-road Mobile Machinery before completing this form.

Pursuant to Section 10 of the Air Pollution Control (Non-road Mobile Machinery) (Emission) Regulation, I hereby apply for exemption of the NRMM not meeting prescribed emission standard for temporary use as described below. In support of my application I submit the following information:

Indicate “N/A” for information not available.

# Put “X” in the appropriate box.

Part A: Information of application
New application #
Re-Submission of application
(Ref of previous application:
)#
Part B: Details of Applicant
Name#
Mr.
Miss
Company / Mrs.
Ms.
HK Government
Department / Name in English (individual or business name):
Name in Chinese (individual or business name):
H.K. Identity Card No. / Certification of Incorporation No.# :
Business Registration Certificate No.:
Correspondence address:
Email address:
Telephone No.: / Fax No.:
# If the applicant is not owner of the NRMM, please fill in Part C below.
Part C: Details of Owner
Name#
Mr.
Miss
Company / Mrs.
Ms.
HK Government
Department / Name in English (individual or business name):
Name in Chinese (individual or business name):
Contact information:
Part D: Information of NRMM
(a)  Information of machine:
Type# / Regulated machine / Non-road vehicle
Air compressor / Private car
Drilling rig / Goods vehicle
Excavator / Bus
Lifting platform / Light bus
Loader / Motor cycle
Mobile crane / Motor tricycle
Mobile generator / Special purpose vehicle
Mobile pump
Road works machine
Others
(Please specify):
Trade name
Model
Serial number
Year of manufacture
(b)  Information of each engine installed in the machine:
Engine 1 (Primary) / Engine 2 (Secondary)
(if applicable) / Engine 3 (Secondary)
(if applicable)
Type#
- CI : compression ignition
- PI : positive ignition / CI
PI / CI
PI / CI
PI
Make
Model
Serial number
Fuel type# / Diesel
Petrol
LPG
Others
(Please specify):
/ Diesel
Petrol
LPG
Others
(Please specify):
/ Diesel
Petrol
LPG
Others
(Please specify):
Rated power output (kW)
Emission standards
(c)  Information of exhaust emission control device (if applicable):
Type
Trade name
Model
Part E: Additional information
Justification:
Purpose of use:
Period of use: / Location of use:
Current location of the NRMM:
Any other relevant information (if applicable):
Part F: Declaration
I declare that to the best of my knowledge and belief, the information given in this application is true and correct. I understand that any person who provides or causes to be provided false or misleading information for acquisition of the exemption commits an offence and is liable to a fine at level 5 and 3 months’ imprisonment. An exemption that is issued in consequence of false or misleading information will be revoked.
Signature of applicant / Name / Position
on behalf of
Company name and chop(if applicable) / Date (Date/ Month/ Year)
Part G: Remarks
A)  Please note that EPD will take about three weeks to process an application for a NRMM label after all necessary documents and photos are received.
B)  Please provide documents of the following to support your application.
1.  a copy of the identification document or business registration certificate of the applicant;
2.  photos showing overall picture of the NRMM, outlook of the engine, details of the information indicated on the machine’s nomenclature plate and its engine’s information label, and their locations on the NRMM;
3.  document to support the ground for the application for exemption; and
4.  any other document or information on the machine or vehicle that the Authority requires.

3

February 2017