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CONSENT TO BEING FINGERPRINTED AND AUTHORIZATION TO DISCLOSE ANY CRIMINAL CONVICTIONS THAT MAY BE RECORDED AGAINST ME

I have applied for a Certificate of No Criminal Conviction and agree to give my fingerprints in connection with this application, as well as for the retention of such by the Hong Kong Police. I also hereby give my consent that all details of any criminal convictions recorded against me in Hong Kong may be disclosed by the Hong Kong Police to the appropriate Consulate / Immigration Authority / Government Authority without prior reference to me.

Date :
Pol. 172B(09/2008)

Signed :

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