Trade and Industry Department
Government of the Hong Kong Special Administrative Region
Chemical Weapons (Convention) Ordinance (Cap. 578)		
Annual Report on Schedule 2 Chemicals –
AntiCIPATED Activities AT Each Plant of a Facility FOR THE COMING YEAR (Form S2-3)	
Part A :	Details of the facility (Note 1)	
1.	Facility name :
     	5.	Facility address :
	     
	     
	     	
2.	Name of the owner, company or enterprise operating the above facility :
     		
(Please mark ‘X’ in one of the following and provide details) :
 HKID no.   Passport no.	 BR no.:        	
 other relevant registration no. (please specify) :      	

Tel no. :      	Fax no. :      	
3.	Permit number :
     	4.	Year of past activities reported in this form 
(i.e. the "reporting year", must be a calendar year) :
     	6.	No. of declared Schedule 2 plants in the above facility :      

	No. of declared Schedule 3 plants in the above facility :      	
Part B :	Details of each Schedule 2 plant of the facility (Please use additional Form S2-3 if necessary)	
1.	Name of the Schedule 2 plant :
     	2.	Name of the owner, company or enterprise operating the plant :
     	
Precise location, including the specific building or structure no. (if any), of the above plant :      	(Please mark ‘X’ in one of the following and provide details) :
 HKID no.  Passport no.	 BR no.:        	
 other relevant registration no. (please specify) :      	
3.	The anticipated activities (Note 5) of the plant in relation to Schedule 2 chemicals (please mark ‘X’ if applicable) : 
	Production				Processing			Consumption  
	Please indicate if the above plant was dedicated (Note 11) to the above activities (please mark ‘X’ in one of the following ) : 
		Dedicated to the above declared activity(ies) only
		Multi-purpose 
	(If it is a multi-purposed plant, please mark ‘X’ for applicable purposes) :
		 Storage			Re-packaging, distribution	
		 Research and development
		 Other (please specify) :      	4.	Use Product Groups Codes to describe main activities of the plant (Note 6) :
	     	
	5. 	This plant will produce Schedule 1 chemicals as an unavoidable by-product in an amount exceeding 3% of the total product or will produce any other chemicals that can be used for chemical weapons purposes: 
		 Yes		 No  (please mark ‘X’ )	
Part C :	Details of each Schedule 2 chemical at the plant (Please use additional Form S2-3 if necessary)	
1. IUPAC chemical name (Note 3) :
     	6.  Any anticipated production, processing or consumption (Note 5) of the chemical in the reporting year (please mark ‘X’) :
 Yes	 No	
2. Common name or trade name :      	If yes, please indicate the quantity (Note 9) involved :	
3. CAS registry no. (Note 4) :      	(a)	Produce 	:	       	  kg  tonne	
4. Structural formula :
     	(b)	Process	: 	       	  kg  tonne	
	(c)	Consume	: 	       	  kg  tonne	
5. 	Anticipated production at the plant :  	 Yes	  No (please mark ‘X)
If yes, please provide the anticipated production capacity of the declared plant for this Schedule 2 chemical in the reporting year (Note 7) : 
       	   kg  tonne
Calculation method (please mark ‘X’ in one of the following):
 Nameplate  Design 	Anticipated time period (in dd/mm/yy) (Note 14) : 	
	(a)	Produce	: from	       	to       		
	(b)	Process	: from	       	to       		
	(c)	Consume	: from	       	to       		
Part D :	Total number of Form S2-3 submitted (including this page) :        	 pages
	(Please submit this form together with Form S2-4. Also see Guideline 12)	
Part E :	Undertaking by the permit holder	
I, the undersigned, hereby declare to the best of my knowledge and belief, that all information provided in this form and in any additional pages attached to this form is true and correct.  I also declare that, in submitting this form, I fully understand that Trade and Industry Department reserves at all times the right to release the above information and any information relates to this report, including particulars of the undersigned, to third parties for purposes stated in Section 28(2) of the Chemical Weapons (Convention) Ordinance (Cap. 578).

Name of the permit holder of the facility :      

Signature of the permit holder and company chop :

Date :      	For official use only

Date of receipt :

Remarks :