CONFIDENTIAL 機密

Official Use Only會方專用

App. No. 申請編號:

CLP Eco Building Fund中電綠適樓宇基金

Application Form for CLP Eco Building Fund (Retro-commissioning Project)中電綠適樓宇基金–申請表格 (重新校驗項目)

(Revision Date: 18 February 2020)(修訂日期：2020年2月18日)

Please read the “Guide to Application – CLP Eco Building Fund” before completing this form. You may complete this Application Form in Chinese or English.

填表前請參閱《中電綠適樓宇基金 - 申請指引》。請以中文或英文填寫本表格。

This Application Form comprises five parts. The Applicant Organisation / Applicant must complete all five parts of this Application Form (if the Applicant Organisation / Applicant requests CLP to grant Approval in Principle, Section A, item 1 in Section B and Section E must be completed), sign the Declaration in the relevant section and enclose all the required documents prior to submission to the CLP Eco Building Fund. Failure to do so may result in delay or failure of your Project being approved for funding.

本表格共分五部份，申請機構 / 申請人必須填妥所有部份（如要求中電授予原則性批核，申請機構 / 申請人必須塡寫甲部、乙部第1項及戊部），並於有關部份的聲明上簽署後，連同有關資料送交中電綠適樓宇基金，否則可導致有關項目資助申請延遲處理或失效。

The completed Application Form together with all the required documents should be returned to the following address by stating “Application to the CLP Eco Building Fund” on the envelope:

請將填妥的表格連同有關資料送交以下地址，信封面請註明「申請中電綠適樓宇基金」：

Business Strategy & Innovation

Customer & Business Development

CLP Power Hong Kong Limited

7/F Shamshuipo Centre

215 Fuk Wa Street

Sham Shui Po

Kowloon

(Application for CLP Eco Building Fund)

九龍深水埗福華街215號7樓

中華電力有限公司

客戶及業務拓展部

業務策略及創新

「申請中電綠適樓宇基金」

Hotline 電話:2678 0322

Fax傳真:2678 6673

E-mail電郵:clpecobldgfund@clp.com.hk

Website 網站:www.clp.com.hk/ecobuildingfund

Notes for Applicant

申請者須知

1. Eligibility of building申請樓宇資格

(a) Residential buildings, commercial buildings, industrial buildings or composite buildings and their ancillary facilities are eligible to apply. 住宅樓宇、商業樓宇、工業樓宇或綜合樓宇，及其鄰近附屬設施均符合申請資格。

2. Eligibility of applicant organisation/applicant申請機構/申請人資格

(a) The buildings with multi-ownership and the following entities (Applicant Organisation) are eligible to apply for the Fund: 符合申請資格並由多名業主擁有的樓宇之機構（申請機構）包括：

· Owners’ Corporations registered under the Building Management Ordinance (Cap. 344); 已根據《建築物管理條例》（第344章）註冊的業主立案法團；

· Owners’ organisations (e.g. Owners’ Committee); or 業主組織（例如業主委員會）；或

· Residents’ organisations (e.g. Mutual Aid Committee) 居民組織（例如互助委員會）。

(b) For the commercial buildings, industrial buildings, or composite buildings without Owners’ Corporation or other owners’ organisations as specified in section 2(a), the owner (Applicant) may apply for the Fund. 沒有上文2(a) 項所訂明的業主立案法團或其他業主組織之商業樓宇、工業樓宇或綜合樓宇，其業主亦可以申請人的身份（申請人）提交申請。

(c) Under special circumstances, the Applicant can be non-building owner, e.g. property management company, provided that written consent from the building owner(s) or proof of authorisation to handle the building related matters can be provided. The Applicant may provide an electricity account registered from relevant communal areas of the building for funding disbursement through billing credit, subject to approval by CLP / Vetting Committee owner.

於特殊情況下，並取得該樓宇相關業主的同意書或授權處理樓宇相關事宜，申請人可為非業主，例如物業管理公司，但須事先得到中電 / 評審委員會批准，並可提交樓宇相關公用地方的登記電力賬戶號碼用作透過扣減電費方式發放資助。

3. Scope of funding 資助範圍

Improvement works to upgrade the energy efficiency of building services installations for communal use in residential buildings, commercial buildings, industrial buildings or composite buildings and their ancillary facilities. Building services installations include lighting, air-conditioning, lift and escalator, and electrical installation. Despite retrofitting projects, retro-commissioning and implementation of smart / IT technologies will also be supported by the Eco Building Fund.

用以提升住宅樓宇、商業樓宇、工業樓宇或綜合樓宇，及其附屬設施的公用地方之屋宇設備裝置能源效益的改善工程。屋宇設備節能改善工程包括照明系統、空調系統、升降機及自動電梯、和電力裝置。另外，計劃亦涵蓋能提升能源效益的工程，當中包括重新校驗和實施智能 / 資訊科技技術。

4. The following documents should be provided 請提交以下文件

(a) For the applications submitted by Applicant Organisation, a certified true copy of documentary proof of the establishment of and / or registration of the Owners’ Corporation, owners’ organisation or residents’ organisation. 若以申請機構名義提出申請，簽署認證成立及/或註冊業主立案法團、業主組織或居民組織證明書的副本。

(b) For the applications submitted by Applicant, proof his / her identity as the owner of the building and authorization document obtained from all the owners of the building.

若以申請人名義提出申請，可證明其樓宇業主身份的文件、及所有業主授權作代表申請的文件。

(c) Under special circumstances, the Applicant can be non-building owner, e.g. property management company, provided that written consent from the building owner(s) or proof of authorisation to handle the building related matters can be provided. The Applicant may provide an electricity account registered from relevant communal areas of the building for funding disbursement through billing credit, subject to approval by CLP / Vetting Committee.

於特殊情況下，並取得該樓宇相關業主的同意書或授權處理樓宇相關事宜，申請人可為非業主，例如物業管理公司，但須事先得到中電 / 評審委員會批准，並可提交樓宇相關公用地方的登記電力賬戶號碼用作透過扣減電費方式發放資助。

5. Person-in-charge of the Project項目負責人

(a) For the applications submitted by Applicant Organisation, the Person-in-charge of the Project can be 若以申請機構名義提出申請，項目負責人可為：

· The chairperson of the applicant organisation; 申請機構的主席；

· A representative of the applicant organisation; 申請機構的代表；

· A representative of the property management company; or 物業管理公司代表；或

· A Qualified Service Provider as specified in paragraph 2.10.1 of the “Guide to Application – CLP　Eco Building Fund”.《中電綠適樓宇基金 - 申請指引》第2.10.1段所指定的合資格服務提供者。

(b) For the commercial and industrial buildings without Owners’ Corporation or other owners’ organisations as specified in section 2(a), Person-in-charge of the Project can be: 沒有上文2(a)項所訂明的業主立案法團或其他業主組織之商業和工業樓宇，項目負責人可為：

· The owner of the building (for building with single ownership only); 樓宇業主（只適用於單一業主擁有的樓宇）；

· The owner of the building as a representative for all the owners of the building (for building with multi-ownership); 樓宇業主並代表樓宇所有業主（適用於由多名業主擁有的樓宇）；

· A representative of a property management company; or 物業管理公司代表；或

· A Qualified Service Provider as specified in paragraph 2.10.1 of the “Guide to Application – CLP　Eco Building Fund”.《中電綠適樓宇基金 - 申請指引》第2.10.1段所指定的合資格服務提供者。

The owner of the building who submits an application on behalf of all the owners of the building and assumes the role of Project person-in-charge, should seek consent in writing from all the owners of the building and attach the relevant consent document to the Application Form. The representative of the Applicant Organisation, the representative of the property management company or a Qualified Service Provider who assumes the role of Project person-in-charge, should seek consent in writing from the Applicant Organisation / Applicant and attach the relevant consent document to the Application Form.

代表該樓宇所有業主提交申請及擔任項目負責人的該樓宇業主，須取得該樓宇所有業主的同意書，並於申請表格夾附有關同意書。而擔任項目負責人的申請機構代表、物業管理公司代表或合資格服務提供者，須取得申請機構 / 申請人的同意書，並於申請表格夾附有關同意書。

(c) For the application submitted by non-building owner, Person-in-charge of the Project can be the Applicant or his/her representative.

若申請人是屬於非業主，項目負責人可為申請人或其代表。

The Person-in-charge of the Project assigned for the application must sign the “Declaration” on page 9 and the “Section E - Declaration” on page 22.

申請項目負責人必須在第9頁的“聲明”及第22頁的“戊部 - 聲明”簽署。

6. Compliance with Building Energy Efficiency Ordinance 符合《建築物能源效益條例》

Please ensure the new installations comply with the relevant energy efficiency standards stipulated in the Building Energy Efficiency Ordinance.

請確保新裝置符合《建築物能源效益條例》所訂明的能源效益標準。

7. Funding reimbursement

(a) If the Applicant Organisation/Applicant belong to section 2(a) or 2(b) mentioned above, the funding shall be reimbursed by cheques payable to one of the following:

若申請機構/申請人是屬於第2(a) 或2(b)項中的類別，資助將給與以下其中一類的支票抬頭人/機構：

(i) The Applicant Organisation, which is either Owners’ Corporation, owners’ organisation or residents’ organisation; or

申請機構（即業主立案法團、業主組織或居民組織）；或

(ii) The account opened under Section 3 of Schedule 7 of the Building Management Ordinance, Cap. 344 as authorised by the applicant (please provide the relevant documentary proof).

申請機構授權根據《建築物管理條例》(第344章)附表7第(3)條開立的戶口（請提供有關的文件證明）; or

(iii) The Applicant or its authorised organisation (please provide the relevant documentary proof).

申請人或其授權的機構（請提供有關的文件證明）。

(b) If the Applicant belongs to the category mentioned in section 2(c), the funding may be reimbursed through billing credit to an electricity account registered for relevant communal area of the building.

若申請人屬於第2(c)項中的類別，資助將可透過扣減樓宇相關的公用地方電力賬戶的電費。

8. If the proposed project in the application commences (i.e. contract awarded or confirmed) before the Approval in Principle or Final Funding Approval has been granted by CLP / CLP Eco Building Fund Vetting Committee, that project will usually NOT be considered unless there are justifiable reasons accepted by CLP / CLP Eco Building Fund Vetting Committee.

如申請書內建議的項目在未獲得中電 / 中電綠適樓宇基金評審委員會的原則性批核或最終資助批核前已展開（例如：簽定 / 批出標書），除了能提出合理及可被中電 / 中電綠適樓宇基金評審委員會接受的原因外，有關工程一般將不會獲得資助。

9. All sections of the Application Form should be completed with supporting documents wherever required. Where the information sought is not applicable or not available, please fill in “NA”.

表格的所有部分均須填寫；如有需要，須提交證明文件。如所須填報的資料不適用或不詳，請填上“不適用”。

10. Incomplete or inaccurate information provided in the applications / notifications may affect the consideration and processing of the applications / notifications, and may result in their being deferred or rejected, and / or other administrative / legal action being taken against the parties concerned.

在有關的申請表／通知書內提供不完整或不正確的資料，將會影響本公司考慮及處理有關之申請，並可能引致申請遭延遲處理或拒絕受理，以及／或導致本公司對有關人士採取其他行政／法律行動。

11. The Application Form must be typed or printed on both sides of a paper.

申請表格須雙面打印或列印。

12. Please give clear and concise information. Additional pages may be attached to the form if such is necessary.

填報的資料須清晰簡潔。如有需要，可另加附頁。

13. Please read the “Guide To Application - CLP Eco Building Fund” carefully, and provide all details of the proposed project.

請詳閱《中電綠適樓宇基金 - 申請指引》，並提供建議項目的詳情。

Section A –Data Sheet (essential for requesting Approval in Principle)

甲 部 –資料頁 (要求原則性批核必須塡寫)

Applicant Organisation / Applicant申請機構 / 申請人

Type of Applicant Organisation / Applicant

申請機構 / 申請人類別

Please put a ”” in the appropriate box. 請在適當的方格內加上””

· Applicant Organisation for a building with multi-ownership

由多名業主擁有的樓宇之申請機構

· Applicant for a commercial / industrial / composite building without Owners’ Corporation or other owners’ organisations

由沒有業主立案法團或其他業主組織的商業 / 工業 / 綜合樓宇之申請人

· Applicant of non-building owner

由非業主之申請人

Charitable Institution

慈善機構

Please put a ”” in the appropriate box if applicable

如適用，請在適當的方格內加上””

· Charitable institutions / trusts of a public character, which are exempt from tax under Section 88 of The Inland Revenue Ordinance

根據《稅務條例》第88條獲豁免繳稅的慈善機構 / 慈善信託

Provision of Public Visits

供公眾參觀

Please put a ”” in the appropriate box if applicable

如適用，請在適當的方格內加上””

· New technology demo project or showcase project which will allow public visits

完成的工程項目可供公眾參觀或作示範用途

Name of Applicant Organisation / Applicant

申請機構 / 申請人名稱

(English英文)

(Chinese中文)

Mailing Address

通訊地址

(English英文)

(Chinese中文)

Please see items 1 to 4 of Notes for Applicant 請參閱申請者須知第1至4項

Person-in-charge負責人

Name

姓名

* Mr. / Ms. / Mrs.

* 先生 / 小姐 / 女士

(English英文)

(Chinese中文)

Position Held

職位

(English英文)

(Chinese中文)

Name of Company/ Organisation

公司或機構名稱

(English英文)

(Chinese中文)

Tel. No.

電話號碼

Fax No.

傳真號碼

Mobile Phone No.

流動電話號碼

E-mail Address

電郵地址

* Delete where not applicable 把不適用者刪去

Please see item 5 of Notes for Applicant 請參閱申請者須知第5項

Building Information樓宇資料

Name of Building

樓宇名稱

(English英文)

(Chinese中文)

Address of Building

樓宇地址

(English英文)

(Chinese中文)

Age of Building

樓宇樓齡

Years

年

Electricity Consumption of the Building

樓宇的用電量

Electricity consumption in the communal areas for the past 12 months

公用地方過去12個月的用電量

度電 (kWh)

Please provide copy of the last electricity bill for reference

請提交最近一期電費單副本作參考

Type of Building樓宇類別

Please firstly fill in the information of all buildings among the applicant organisation where the building(s) applying for funding is located, and then fill in the information of the building(s) applying for funding. 請先填寫需要申請基金的樓宇所屬申請機構的所有樓宇資料，然後填寫需要申請基金的樓宇資料。

Overall Information of Applicant Organisation’s Buildings 申請機構的所有樓宇資料

Total Number of Residential Block

住宅樓宇總座數

Blocks

座

Total Number of Commercial Block

商業樓宇總座數

Blocks

座

Total Number of Industrial Block

工業樓宇總座數

Blocks

座

Total Number of Composite Block

(please specify type: )

綜合樓宇總座數

(請註明類別: )

Blocks

座

Ancillary Facility Type

附屬設施的種類

Number of Ancillary Facility

附屬設施數目

Podium 平台

Clubhouse 會所

Others (please specify: )

其他 (請註明: )

Information of Building Applying for Funding 申請基金的樓宇資料

For funding limit details, please refer to Section 2.4 & Section 2.5 of the “Guide to Application – CLP Eco Building Fund”. 有關資助限額詳情，請參考《中電綠適樓宇基金 - 申請指引》第2.4 及2.5段。

Type of Building (Residential / Commercial / Industrial / Composite Block, Clubhouse etc.)

樓宇類別（住宅 / 商業 / 工業 / 綜合、會所等）

Ancillary Facility form part of Residential / Commercial / Industrial / Composite Building? (Yes / No / N/A) 附屬設施是否住宅 / 商業 / 工業 / 綜合樓宇內的一部份? （是 / 否 / 不適用）

1

e.g. Residential例如: 住宅

N/A (Residential Only)不適用(只有住宅)

2

e.g.Clubhouse例如: 會所

Yes是

1

2

3

4

Please extend the table if necessary 如有需要，請擴充表格

Energy Assessment Conducted for the Building Applying for Funding

就申請本基金的樓宇已進行的能源評估

Please put a “ ” in the appropriate box(es) and provide relevant assessment report(s) (if any)

請在適當的方格內加上“ ”並提交相關的評估報告書(如有)

· Energy audit 能源審計

For this option, please put a”” in either one of the appropriate boxes on the right.如選此項, 請也在右邊其中一個適當的方格內加上“”

· by CLP 中電提供

· by Others 其他機構提供

· Carbon audit 二氧化碳排放審計

· Energy-cum-carbon audit 能源及二氧化碳排放綜合審計

· No audit conducted 沒有進行審計

CLP is offering free energy audit service, for details please refer to CLP web page https://www.clp.com.hk/en/my-business/energy-saving-service/energy-audit-service-and-loan-scheme

中電提供免費能源審計服務，詳情請參閱中電網頁https://www.clp.com.hk/zh/my-business/energy-saving-service/energy-audit-service-and-loan-scheme

Assessment Registered for the Building Applying for Funding

就申請本基金的樓宇已登記將進行的評估

Please put a “ ” in the appropriate box(es) and provide relevant registration letter

請在適當的方格內加上“ ”並提交相關的登記證明

· BEAM Plus (Energy Use) introduced by Hong Kong Green Building Council

由香港綠色建築議會推出的綠建環評（能源使用）

Amount of Fund Requested

申請基金總額

HK$

港元

Cheque Payable to or Electricity Account Registered for Relevant Communal Area of the Building for Billing Credit

支票抬頭人 / 機構或透過扣減樓宇相關公用地方電費的登記電力賬戶號碼

(Please see item 7 of Notes for Applicant請參閱申請者須知第7項)

Contact Person in CLP 中電聯絡人

Please fill in the information of CLP staff (e.g. Account Manager) introducing to you CLP Eco Building Fund, if any

請填寫向您介紹中電綠適樓宇基金的中電職員（例如客戶經理）的資料（如有）

Name of Contact Person

聯絡人姓名

Position Held

職位

Telephone Number

電話號碼

Declaration 聲明

I certify that 本人謹此聲明 –

1. all activities seeking grant of fund are non-profit-making and will not be used for political, religious or commercial purposes for any individual or organisation;所有申請資助的活動均屬非牟利性質，且非為個人或團體作政治、宗教或商業宣傳之用；

2. the information provided in this form is complete, true and correct to the best of my knowledge; and據本人所知，本表格內填報的資料均為完整並正確無訛；及

3. the applicant understands and agrees to comply with the terms and conditions as set out in the “Guide to Application – CLP Eco Building Fund” and will comply with all the requirements laid down in the Funding Agreement should the applicant be granted fund for the project.

申請機構明白並同意遵守《中電綠適樓宇基金 - 申請指引》所列之條款；如獲基金資助，申請機構會遵守基金資助協議書所列的各項規定。

Signature 簽署

Name of Person-in-charge

負責人姓名

( )

Date 日期

Official Chop 機構印章

Warning警告

Any intentional misrepresentation or omission of information related to this application may result in the application being rejected, grant withheld and the applicant may be liable for prosecution. The applicant's explicit attention is drawn to the fact that obtaining pecuniary advantage by deception is a criminal offence.

凡故意在本申請中作失實陳述或漏報資料，可導致遭拒絕、中止發放撥款及遭起訴。申請者須注意，以欺騙手段取得金錢利益，屬於刑事罪行。

Section B –Content of Project Proposal

乙 部 –項目建議書的內容

1. Information of the Project (essential for granting Approval in Principle) 工程項目資料 (要求原則性批核必須塡寫)

(For example: replace existing 1,000 nos. of 1,200mm T8 fluorescent tubes with 1,200mm LED tubes)

(例如：更換現有的1,000支1,200mm T8光管為1,200mm LED 光管)

2. Duration of the whole Project 整個項目進行時間

Please specify commencement and completion date for the whole project

請註明整個項目的開始及完成日期

Expected Commencement Date of the whole Project

預計整個項目開始日期

Expected Completion Date of the whole Project

預計整個項目完成日期

3. Name of Qualified Service Provider, if engaged (please provide the relevant documentary proof)

若有聘請合資格服務提供者，請提供姓名（請提供有關的文件證明）

(English 英文)

* Mr. / Ms. / Mrs.

(Chinese中文)

* 先生 / 小姐 / 女士

Position Held

職位

Name of Company/ Organisation

公司或機構名稱

Tel. No.

電話號碼

Fax No.

傳真號碼

Mobile no.

流動電話號碼

E-mail Address

電郵地址

* Delete where not applicable 把不適用者刪去

Qualified Service Provider must be a Registered Energy Assessor stipulated under the Building Energy Efficiency Ordinance (Cap. 610) 合資格服務提供者必須為根據《建築物能源效益條例》（第 610 章）註冊的註冊能源效益評核人

4. Estimated Expenditure 預算開支

Please fill in project details in “Details on the Works Projects” in Page 16 請於第16頁的“工程項目的詳細資料”填寫工程項目細節

4.1Capital Items & Goods of Projects 工程項目的資本物品及物品

Particulars項目

Total Estimated Expenditure of Each Item (HK$)每項總預算開支(港元)

Total總計：

Please extend the table if necessary 如有需要，請擴充表格

4.2Service Charge of Qualified Service Provider (if engaged) 合資格服務提供者（若有聘請）的服務收費

Estimated Expenditure (HK$) 預算開支(港元)：

5. Sources of Funding from other Funding Scheme(s) with the Same Installation Items in this Application 其他資助計劃的資助（與此申請相同的工程項目）

For the installation items in this application, please fill in sources of funding from other funding schemes. Please include funding granted or applying for funding. 就此申請的工程項目，請填寫其他資助計劃的資助。請包括已獲批准或正在申請的資助。

Name of the First Funding 首個資助計劃名稱

Fund Organisation 資助機構

Items Applied for Funding

申請資助的項目

Types of Installation (e.g. Lighting)

項目類別(例如: 照明)

Applied / Granted Date (Please specify type of date) 申請 / 獲批日期 (請註明日期類別)

Applied / Granted Amount (HK$) 已申請或獲批資助總額(港元)

Name of the Second Funding 第二個資助計劃名稱

Fund Organisation 資助機構

Items Applied for Funding

申請資助的項目

Types of Installation (e.g. Lighting)

項目類別(例如: 照明)

Applied / Granted Date (Please specify type of date) 申請 / 獲批日期 (請註明日期類別)

Applied / Granted Amount (HK$) 已申請或獲批資助總額(港元)

Please extend the table if necessary 如有需要，請擴充表格

6. Estimated Revenue Generated from the Project (e.g. sale of building services installations to be replaced) 項目的預算收入（例如出售需予替換的屋宇設備裝置帶來的收入）

7. Total Amount of Fund Applied 申請資助總額

Applicable to Retro-commissioning Project

適用於重新校驗項目

Item 項目

Amount(HK$) 總額(港元)

A.

Estimated Expenditure 預算開支

A1.Capital Items & Goods of Projects 工程項目的資本物品及物品

(Item 3.1 above 上文第 3.1 項)

A2.Qualified Service Provider Service 合資格服務提供者提供的服務

(Item 3.2 above 上文第 3.2 項)

B.

Sources of Funding from other Funds / Funding Schemes 其他基金 / 資助計劃的資助

(Item 4 above 上文第 4 項)

C.

Estimated Revenue Generated from the Project 項目的預算收入

(Item 5 above 上文第 5 項)

D.

Estimated Annual Energy Saving (kWh/year)

估計每年節省能源(度電/年)

E.

Total Amount of Fund Applied 申請資助總額

D x S - B - C or 或 A1 + A2 - B - C,

whichever is lower 以較低者為準

S is the subsidy amount ($/kWh/year). To find the suitable subsidy amount for the project, please refer to the paragraph 2.4 of Guide to Application – CLP Eco Building Fund.

S 為可獲的資助 ($/kWh/year) ，請參考《中電綠適樓宇基金 - 申請指引》第2.4段有關適用的項目資助

(Please state calculation details clearly and refer to the paragraphs 2.4, 2.5, 3.2.7, 3.2.8 & 3.2.9 of the Guide to Application – CLP Eco Building Fund)

(請清楚詳列出計算方法及參考《中電綠適樓宇基金 - 申請指引》第2.4, 2.5, 3.2.7, 3.2.8及3.2.9段)

8. Proposed Plan for Disbursement of Fund (Not applicable if funding disbursement through billing credit applies. Please also see paragraph 5.3 of the Guide to Application – CLP Eco Building Fund) 建議款項發放時間表（不適用於透過扣減電費方式發放資助，並請參閱《中電綠適樓宇基金 - 申請指引》第5.3段）

Amount(HK$)

總額(港元)

Proposed Date of Payment

建議發放日期

Disbursement Plan

發放時間表

Final Payment

(Minimum 10% of total approved amount)

最後一期發放款項

(最少為總獲批款項的10%)

9. Record of Previous Applications which are either Supported or Rejected by CLP / CLP Eco Building Fund Vetting Committee 以往曾獲中電 / 中電綠適樓宇基金評審委員會批准或遭拒絕的申請記錄

Building Name and Application No. of Project Approved獲批准的樓宇名稱及

申請編號

Approval Date獲批日期

Granted Amount

(HK$) 資助金額

(港元)

Completion Date完成日期

Date to Submit Completion Report 提交完成報告書的日期

Building Name and Application No. of Project Rejected遭拒絕的樓宇名稱及申請編號

Applied Amount (HK$)

申請資助金額

(港元)

Submission Date申請日期

10. Details of other Environmental Initiatives Implemented / Planned to be Implemented in the Building 其他已在樓宇實施 / 計劃實施的環保措施

11. Other Relevant Information in Support of your Application 其他支持申請的相關資料

CONFIDENTIAL 機密

1

32

Revision Date: 18 Feb 2020

修訂日期：2020年2月18日

Official Use Only會方專用

App. No. 申請編號:

Details on the Works Projects工程項目的詳細資料

This part should be completed by the Qualified Service Provider (if engaged). In order to provide a better understanding of the work scope and total project cost, applicants are required to attach the tender documents or quotations with their Application Form.

此部分應由合資格服務提供者(若有聘請)填寫。申請者請在申請書中夾附工程部分的標書或報價單，以便準確估計工程的內容及整體費用。

1. Please provide details of the proposed works items as chosen above: 請就以上所選取的工程項目提供更詳細的資料：

Retro-commissioning 重新校驗

Before Project Commencement 展開項目前

Equipment Name

設備名稱

Rated Power (kW)

功率 (千瓦)

(a)

Quantity

數量

(b)

Estimated Annual Operating Hours

估計每年使用時數

(c)

Annual Average Load Factor (%)

每年平均負荷系數

(d)

Estimated Annual Energy Consumption (kWh/year)

估計每年消耗能源(度電/年)

(e) = (a) x (b) x (c) x (d)

Installed Location

安裝地點

After Project Completion 完成項目後

Equipment Name

設備名稱

Rated Power (kW)

功率 (千瓦)

(f)

Quantity

數量

(g)

Estimated Annual Operating Hours

估計每年使用時數

(h)

Annual Average Load Factor (%)

每年平均負荷系數

(i)

Estimated Annual Energy Consumption (kWh/year)

估計每年消耗能源(度電/年)

(j) = (f) x (g) x (h) x (i)

Estimated Annual Energy Saving (kWh/year)

估計每年節省能源(度電/年)

(k) = (e) – (j)

Unit Price (HK$)

單價(港元)

Estimated Cost (HK$)

預算開支 (港元)

Installed Location

安裝地點

2.

3. Declaration by the Qualified Service Provider (if engaged)合資格服務提供者(若有聘請)的聲明

(a) Are you an employee, employer, shareholder, agent, director, relative or friend of the project contractor or tenderer? 你是否項目承辦商或投標商的僱員、僱主、股東、代理人、董事、親屬或朋友？ Please put a “” in the appropriate box. 請在適當方格內加上””

· No不是

· Yes是 (Please specify the relationship with you請填寫項目承辦商或投標商與你的關係)

(b) Are you a member of applicant organisation or a relative or friend of the member of applicant organisation? 你是否申請機構的委員或申請機構委員的親屬或朋友？ Please put a “” in the appropriate box. 請在適當方格內加上””

· No不是

· Yes是 (Please specify the relationship with you請填寫申請機構或其委員與你的關係)

(c) I certify that the information provided above is complete, true and correct to the best of my knowledge.本人謹此聲明據本人所知，上述填報的資料均為完整並正確無訛。

Please check ”” this box if you consent that CLP Group companies within Hong Kong may use your personal data to market to you energy services, electrical products, CLP Group organised events, and make appeals for non-profit organisations. (Leave the box blank shall not replace any choice regarding direct marketing that you have communicated to CLP prior to this application)

如你同意接收中電集團在香港的公司使用你的個人資料，向你傳遞電力服務、電器產品、舉辦活動的推廣資訊，以及非牟利機構的呼籲，請於方格填上””號 （留空此方格不會取代你在此申請前已經向中電表達之任何有關直接促銷的選擇）

Signature 簽署

Name of Qualified Service Provider

合資格服務提供者姓名

( )

Date

日期

Section C –Personal Data Collection Statement

丙 部 –收集個人資料的聲明

CLP Power Hong Kong Limited (CLP) is committed to your privacy and committed to implementing the requirements of the Personal Data (Privacy) Ordinance (Ordinance) by taking all reasonable steps to safeguard your personal data from unauthorized access, processing, erasure or other use during collection, holding, processing, using and transfer. This Statement informs you about our responsibilities and your rights under the Ordinance in respect of our collection of your personal data. 中華電力有限公司（中電）致力保障申請機構的私隱及遵從《個人資料（私隱）條例》（《私隱條例》）之規定，採取一切合理措施，確保閣下的個人資料於收集、持有、處理、使用及轉移過程中，不會在未經授權下被查閱、處理、删除或作其他用途。本聲明旨在告知閣下，本公司在收集閣下的個人資料方面，乃根據《私隱條例》之所應負的責任以及閣下所享有的權利。

Purpose of Collection of Personal Data

收集個人資料的用途

Personal data provided in your CLP Eco Building Fund Application Form and other related documentation will be used by CLP for considering and processing your CLP Eco Building Fund application and for other directly related purposes. You may choose whether or not to provide us with personal data. However, in the absence of the personal data that was, at the time of collection, either specified as mandatory or not optional, your application to the CLP Eco Building Fund may be delayed, deferred or rejected due to inability to assess your application. 閣下於中電綠適樓宇基金下之申請表及其他有關文件所提供之個人資料，將供中電用於考慮及處理閣下之中電綠適樓宇基金申請，及其他與此目的直接有關之用途。你可選擇是否提供個人資料。然而，若缺乏所需的個人資料（包括必須填寫的資料或非選擇提供的資料），則可能因為無法進行甄選而導致申請延誤或拒絕受理。

Transfer of Personal Data

轉移個人資料

The data collected in your CLP Eco Building Fund Application Form and other related documentation will be kept in confidence. The data may however be disclosed to the following third parties:

(a) the CLP Eco Building Fund Vetting Committee;

(b) related CLP companies, including subsidiaries and affiliated companies within the CLP Group in Hong Kong;

(c) service providers (including service providers outside Hong Kong) engaged by CLP for any of the purposes stated above; and

(d) entities (including entities outside Hong Kong) for conducting research and preparing statistics relating to any of the purposes stated above.

CLP will disclose your personal data when required to do so by the law and may also disclose such data in response to requests from law enforcement agencies or other government bodies / regulatory bodies / related organisations, or if explicit consent to such disclosure is given by the applicant.

本公司對中電綠適樓宇基金申請表及有關文件內的個人資料嚴格保密。然而，本公司或會將該等資料向以下第三者披露：

(a) 中電綠適樓宇基金評審委員會;

(b) 與中電有關的公司包括中電集團在香港的子公司及其附屬公司;

(c) 與此基金申請有關而為中電提供服務的服務供應商（包括香港以外的服務供應商）;及

(d) 與此基金申請有關而進行調查及統計的單位（包括香港以外的單位）。

若根據法律規定或因應執法機關／政府機構／有關機構的要求或已獲有關申請機構同意，中電將會披露申請機構的個人資料。

Access to and Correction of Personal Data

查閱及更正個人資料

You have a right to request access to, and the correction of, your personal data in accordance with the provisions of the Personal Data (Privacy) Ordinance (Cap. 486). Requests for access and correction should be made in writing to CLP Eco Building Fund Office, Business Strategy & Innovation, Customer & Business Development, CLP Power Hong Kong Limited, 7/F Shamshuipo Centre, 215 Fuk Wa Street, Sham Shui Po, Kowloon. A charge will be made to cover the cost of photocopying the data supplied. 根據《個人資料(私隱)條例》(第486章)，你有權查閱及更正你的個人資料。有關索閱及更正任何有關你的個人資料要求，請致函九龍深水埗福華街215號7樓，中華電力有限公司，客戶及業務拓展部，業務策略及創新，中電綠適樓宇基金辦公室。本公司會就所提供的個人資料，收取影印費用。

Privacy Policy Statement

私隱政策聲明

You can find out more about CLP’s policies on privacy and personal data protection by accessing our privacy policy statement available on the CLP website at www.clp.com.hk 你可以登入中電的網站 www.clp.com.hk 查閱中電的私隱政策聲明，以了解更多關於中電在私隱及個人資料保障方面的政策。

Section D –Terms & Conditions

丁 部 –條款及細則

To receive funding from the CLP Eco Building Fund, the Applicant Organisation / Applicant must agree to the following Terms and Conditions: 如欲申請並獲得中電綠適樓宇基金，申請機構／申請者必須同意以下條款及細則：

It is the responsibility of the Applicant Organisation / Applicant to obtain tendering bids or quotations for the project and to verify that the proposed system / equipment is fit for the purpose required and suitable for both installation at the proposed location and integration into the existing systems / production processes. 申請機構／申請者有責任就項目向供應商索取標書或報價及核實所建議的系統／設備符合項目需要，且適合安裝於建議的位置及能與現有的系統／生產程序兼容。

CLP Power Hong Kong Limited (CLP) and / or CLP Eco Building Fund Vetting Committee reserves the right to reject any tendering bids / quotations / cost estimates / energy saving estimates which may be unreasonable or otherwise at its absolute discretion to assess the cost and energy saving estimates. Such assessment shall be final and binding on the Applicant Organisation / Applicant. 中華電力有限公司（中電）及／或中電綠適樓宇基金評審委員會保留權利拒絕任何不合理的報價／成本預計／能源節省量估算，或有絕對自由評估成本及能源節省量的估算。此類評估將是最終定案並對申請機構／申請者附有約束力。

If the applicable tariff to a CLP Power’s electricity account is changed from Bulk Tariff or Large Power Tariff to Non-Residential Tariff without change of the electricity account number during the effective period of CLP Eco Building Fund, the account shall be eligible for funding application with a new funding ceiling amount under Non-Residential Tariff. And its funding ceiling amount for that specific year will be equal to the new funding ceiling amount per year subtracting the approved funding amount in the same year. 如賬戶用電價目於此計劃有效期内由大量用電價目或高需求用電價目變更為非住宅用電價目，但賬戶號碼不變，其資助上限亦將變更為等於非住宅用電價目賬戶的額度。而該年的資助上限將等於非住宅用電價目賬戶的資助上限扣除在此前並於同一年所獲批的資助金額。

If the applicable tariff to a CLP Power’s electricity account is changed from Non-Residential Tariff to Bulk Tariff or Large Power Tariff without change of the electricity account number during the effective period of CLP Eco Building Fund, the account shall be eligible for funding application with a new funding ceiling amount under Bulk Tariff or Large Power Tariff. And its funding ceiling amount for that specific year will be equal to the new funding ceiling amount per year subtracting the approved funding amount in the same year. If the result is a negative amount, the new funding ceiling amount for that specific year will be zero for the electricity account. 如賬戶用電價目於此計劃有效期内由非住宅用電價目變更為大量用電價目或高需求用電價目，但賬戶號碼不變，其資助上限亦將變更為等於大量用電價目或高需求用電價目賬戶的額度。而該年的資助上限將等於大量用電價目或高需求用電價目賬戶的資助上限扣除在此前並於同一年所獲批的資助金額。如扣除之後，資助金額為負數，則此電力賬戶於該年新的資助上限為零。

The energy efficiency project(s) set out herein shall be undertaken by the Applicant Organisation / Applicant at its own risk. None of CLP nor any of the companies engaged by CLP, CLP’s employees, directors, officers, agents, advisers or contractors shall be liable for any advice or assistance provided in connection with the energy efficiency project. 申請機構／申請者須承擔上述能源效益項目的相關風險。中電、中電僱用的公司、中電的員工、董事、主任、代理商、顧問或承辦商並不會因提供與能源效益項目相關建議或協助而負上法律責任。

Neither CLP nor the CLP Eco Building Fund Vetting Committee shall under any circumstances be responsible or liable for any incidental or consequential damages whatsoever, including without limitation damages for personal injury, death, loss of profits, loss of confidential or other information, business interruption, failure to meet any duty, arising out of or in any way related to the application of the CLP Eco Building Fund. 不論任何情況下，中電或中電綠適樓宇基金評審委員會並不會就因中電綠適樓宇基金申請引起或與其關連而導致的任何偶發性或因果性損害負上義務或法律責任，此包括但不限於人身傷害賠償、死亡、利益損失、機密或其他資料遺失、業務中斷、未能履行任何責任。

All information provided in this Application Form and subsequently to CLP and / or the CLP Eco Building Fund Vetting Committee is complete, true and correct to the best of the Applicant Organisation’s / Applicant’s knowledge and the Applicant Organisation / Applicant shall immediately notify CLP in writing of any change to the details of the Applicant Organisation / Applicant and / or the project. 在此申請表內或之後所提交予中電及／或中電綠適樓宇基金評審委員會的一切資料，據申請機構／申請者所知，必須為完整並真確無訛 ◦ 資料如有任何更改(包括申請機構／申請者資料及／或工程項目資料)，申請機構／申請者必須立即以書面通知中電。

CLP, CLP Eco Building Fund Vetting Committee and / or the HKSAR Government may at their discretion verify the system / equipment purchase, related installation and usage and the resulting energy saving. Upon request, the Applicant Organisation / Applicant must be able to prove accuracy of information provided in this Application Form. 中電、中電綠適樓宇基金評審委員會及／或香港特別行政區政府可自行核對系統／設備的購買、相關安裝及使用，及最終的能源節省量 ◦ 因應要求，申請機構／申請者必須證明此申請表內所提交資料的準確性。

CLP will disclose your application information when required to do so by the law and may also disclose such information in response to requests from law enforcement agencies or other government bodies / regulatory bodies / related organisations, or if explicit consent to such disclosure is given by the Applicant Organisation / Applicant. 若根據法律規定或因應執法機關／政府機構／有關機構的要求或已獲有關申請機構／申請者同意，中電將會披露申請機構／申請者的申請資料。

CLP reserves the right to add, vary and / or amend any of these Terms and Conditions at any time without notice to the Applicant Organisation / Applicant at the absolute discretion of CLP. 中電保留權利並有絕對自由隨時增訂及／或更改本條款及細則的任何部份，而不須通知申請機構／申請者。

In case of any inconsistency between the English version and the Chinese version of these terms and conditions, the English version shall prevail. 如本條款及細則之中文譯本與英文版本有歧義， 概以英文版本為準。

These terms and conditions shall be governed and construed in accordance with the laws of the Hong Kong Special Administrative Region. 上述條款及細則須受香港特別行政區法律所規管並依其法律詮釋。

Section E –Declaration

戊 部 –聲明

By signing below, I declare that I have read and understood all sections in this Application Form and agree to comply with the terms and conditions set forth in Section D and in the “Guide to Application – CLP Eco Building Fund”. I also declare that the information provided in this Application Form is complete, true and correct, to the best of my knowledge.

本人謹此簽署作實，聲明本人已細閱並明白此申請表內全部內容，並同意接受丁部及《中電綠適樓宇基金 - 申請指引》內的條款及細則的約束，本人亦聲明此申請表上提供的資料，據本人所知，全部均為完整並真確無訛。

Please check ”” this box if you consent that CLP Group companies within Hong Kong may use your personal data to market to you energy services, electrical products, CLP Group organised events, and make appeals for non-profit organizations. (Leave the box blank shall not replace any choice regarding direct marketing that you have communicated to CLP prior to this application)

如你同意接收中電集團在香港的公司使用你的個人資料，向你傳遞電力服務、電器產品、舉辦活動的推廣資訊，以及非牟利機構的呼籲，請於方格填上””號 (留空此方格不會取代你在此申請前已經向中電表達之任何有關直接促銷的選擇)

Signature 簽署

Name of Person-in-charge負責人姓名

( )

Date 日期

Note注意 :

· Please refer to a check list in the next page to check the documents required to be submitted together with the completed Application Form for funding approval. 請參閱下頁的清單檢查提交資助審批申請時所需的文件。

· Please photocopy this Form if more than one is required. 如需要超過一份表格，請自行影印。

· This Form may be amended by CLP / CLP Eco Building Fund Vetting Committee as and when necessary. 中電／中電綠適樓宇基金評審委員會可隨時按需要修訂本表格的內容。

Checklist of Required Documents for Funding Approval

審批資助申請所需文件清單

Item

項目

Application submitted by Applicant Organisation

以申請機構名義提交申請

Application submitted by Applicant

(for commercial, industrial,

or composite building only)

以申請人名義提交申請

（只適用於商業樓宇、工業樓宇或綜合樓宇）

Application submitted by non-building owner

以非業主身份提交申請

Method of funding disbursement

發放資助款項方式

Cheque 支票

Billing credit to electricity account registered for relevant communal area of the building to offset electricity expenses

透過扣減樓宇相關公用地方的電力賬戶電費

Essential Documents for Application 必須提交的文件

Application Form

申請表格

Application form filled with all required information已塡妥所需資料的申請表格

Tendering bids / quotations

標書 / 報價單

Copy of sufficient number of tendering bids or quotations received from the prospective suppliers

according to the application requirement (with cost breakdown of energy saving parts)

按申請要求提交足夠數量的標書或報價單（連同與節能有關部份的價格細項）

Electricity consumption record

電費單

Copy of electricity consumption record in last month 最近一期的電費單副本

Proof of bank account

銀行戶口證明

Copy of documentary proof of the bank account

of cheque payable for funding disbursement

用作領取資助的支票抬頭人 / 機構之銀行戶口證明文件副本

Not applicable

不適用

Proof of Applicant Organisation / Applicant

申請機構 / 申請人之證明

A signed and certified true copy of documentary proof of the establishment of and / or registration of the following corporation / organization:

下列申請機構之證明文件的認證副本：

· Owners’ Corporation; or

業主立案法團；或

· Owners’ Organisation; or

業主組織 ；或

· Residents’ Organisation

居民組織

A copy of documentary proof of ownership of the building

能證明申請人為

樓宇業主身份之證明文件副本

Not applicable

不適用

Proof of the Person-in-charge of the Project

項目負責人之證明

Any of the following documentary proof of the Person-in-charge of the Project:

可證明項目負責人為下列其中一項的證明文件：

· Chairperson of the Applicant Organisation (e.g. copy of minutes of meeting); or

申請機構的主席（例如：會議記錄副本）；或

· A written consent from the Applicant Organisation confirming that the representative of the Applicant Organisation assumes the Person-in-charge of the Project; or

申請機構的同意書確認申請機構的代表出任項目負責人；或

· A written consent from the Applicant Organisation confirming that the representative of a property management company assumes the Peron-in-charge of the Project; or

申請機構的同意書確認物業管理公司的代表出任項目負責人；或

· If Qualified Service Provider (QSP) has been engaged, a written consent from the Applicant Organisation confirming that the QSP assumes the Person-in-charge of the Project

若已聘請合資格服務提供者，申請機構的同意書確認合資格服務提供者出任項目負責人

Any of the following documentary proof of the Person-in-charge of the Project :

可證明項目負責人為下列其中一項的證明文件：

· The owner of the building (for building with single ownership only); or

該樓宇業主（只適用於單一業主的樓宇）；或

· A written consent from all the owners of the building confirming that an owner of the building represents all the owners to submit application and assumes the Person-in-charge of the Project (for building with multi-ownership); or

該樓宇所有業主的同意書確認其中一名業主代表該樓宇所有業主提交申請並出任項目負責人（適用於由多名業主擁有的樓宇）；或

· A written consent from the Applicant confirming that a representative of a property management company assumes the Person-in-charge of the Project; or

申請者的同意書確認物業管理公司的代表出任項目負責人；或

· If Qualified Service Provider (QSP) has been engaged, a written consent from the Applicant confirming that the QSP assumes the Person-in-charge of the Project

若已聘請合資格服務提供者，申請者的同意書確認合資格服務提供者出任項目負責人

Not applicable

不適用

Documents for Optional Items非必須提交的文件

Qualified Service Provider (QSP)

合資格服務提供者

Copy of qualification of Qualified Service Provider (QSP),

e.g. Certificate of Registered Energy Assessor, if QSP has been engaged

若有聘請合資格服務提供者，需提交其資歷證明副本，例如：註冊能源效益評核人的證書