Form for Nomination and Consent of Nomination HYD 83 (Rev.

11/2010)

To: Chief Highway Engineer/*HK /*Kln /*NT

Highways Department Date:

Part I (To be completed by the Permittee)

Nomination by Permittee
According to Section 10H (1) of the Land (Miscellaneous Provisions) Ordinance (Cap. 28), I nominate the
following contractor as the nominated permittee of excavation permit no.
Contractor’s name:
(in block letters)

#
Signature: Date:
+
Name and post of the person signing
this form for and on behalf of the
Permittee: (in block letters)

Permittee’s Name:
(in block letters)
Permittee’s Fax No.:

Part II (To be completed by the Nominated Contractor)

Nominated Contractor’s Consent and Agreement
According to Section 10I (1) of the Land (Miscellaneous Provisions) Ordinance (Cap. 28), I consent to the
nomination and agree to comply with the conditions in the excavation permit number
to be complied with by the nominated permittee.

#
Signature: Date:
Name and post of the person signing this form
for and on behalf of the Nominated Contractor:
(in block letters)

Nominated Contractor’s Name:

(in block letters)
Nominated Contractor’s Fax No.:

Part III (To be completed by the Authority)

To: The Permittee and the *Nominated Permittee/Nominated Contractor Date:
Approval/Disapproval of Nomination
According to Section 10J (1) of the Land (Miscellaneous Provisions) Ordinance (Cap. 28), I
*approve/disapprove the nomination of the above contractor as the nominated permittee of the excavation
permit no. .

for Director of Highways :

( )
Note: *Delete as appropriate
# Stamp the company chop beside the signature
+If the permittee is an individual person (i.e. not a company), the name of the permittee shall be used.