Trade and Industry Department
Government of the Hong Kong Special Administrative Region
Chemical Weapons (Convention) Ordinance (Cap. 578)		
ANNUAL REPORT ON SCHEDULE 2 CHEMICALS –
PURPOSES FOR PRODUCTION, PROCESSING AND CONSUMPTION OF EACH CHEMICAL FOR THE COMING YEAR (FORM S2-4)	
Part A : Details of the facility (Note 1) and the chemical (Please use a new Form S2-4 for each chemical)	
1.	Facility name :      	4.	CAS registry no. (Note 4):      	
2.	Permit number :      	5.	Year of activities anticipated in this form
(i.e. the 'reporting year', must be a calendar year) :      	
3.	IUPAC chemical name (Note 3) :      		
Part B : Purposes of production, processing and consumption (Note 5) of the chemical named in Part A	
Please mark ‘X’ if applicable :
	Processing and/or consumption on site, the Product Group Codes (Note 6) of the final products are:        	
	Sale or transfer within Hong Kong or to Mainland China
(please provide details in Part C below)
	Direct export other than to Mainland China
(please provide details in Part D below)
	Other (please provide details in Part E below)	
Part C : Details of sale/transfer within Hong Kong or to Mainland China (Please use additional Form S2-4 if necessary)	
Transaction 1
Please mark ‘X’ in one of the following 
destination types (Note 12) and provide details:
	Other industry	
	Trader
	Other destination
Anticipated recipient's name and address :
     	Transaction 2
Please mark ‘X’ in one of the following 
destination types (Note 12) and provide details:
	Other industry	
	Trader
	Other destination
Anticipated recipient's name and address :
     	Transaction 3
Please mark ‘X’ in one of the following 
destination types (Note 12) and provide details:
	Other industry	
	Trader
	Other destination
Anticipated recipient's name and address :
     	
Anticipated quantity to be sold/transferred :
       	  kg  tonne
Final product type (please provide the Product Group Codes) (Note 6):      	Anticipated quantity to be sold/transferred :
       	  kg  tonne
Final product type (please provide the Product Group Codes) (Note 6):      	Anticipated quantity to be sold/transferred :
       	  kg  tonne
Final product type (please provide the Product Group Codes) (Note 6):      	
Part D : Details of direct export other than export to Mainland China (Please use additional Form S2-4 if necessary)	
Transaction 1
Anticipated recipient's destination : 
     
Anticipated quantity :      	  kg  tonne	Transaction 2
Anticipated recipient's destination :
     
Anticipated quantity :      	  kg  tonne	Transaction 3
Anticipated recipient's destination :
     
Anticipated quantity :      	  kg  tonne	
Part E : Other purposes of production, processing and consumption of the chemical named in Part A	
Please mark ‘X’ if applicable :
 Storage	 Re-packaging, distribution	 Research and development
 Others (please specify) :      	
Part F : Total number of Form S2-4 submitted (including this page) :        	 pages
        (Please submit this form together with Form S2-3. Also see Guideline 12)	
Part G : 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 :