香港特別行政區政府
民航處
Civil Aviation Department
The Government of the Hong Kong Special Administrative Region

操作無人駕駛飛機系統的申請(無人機系統) (表格第e-DCA 255號)
Application for Operating Unmanned Aircraft Systems (UAS) (Form e-DCA 255)


填寫表格前,請先細閱表格後的附註。
Please read the NOTES appended at the end of this form carefully before completing it.

1.
申請人姓名(見註3)
Name of applicant (see Note 3)
2.
操作無人機系統的公司名稱(如與上述不同)
Name of company operating the UAS (if different from the above)
3.
公司地址
Company address
4.
聯絡人姓名
Contact Person
Mr. 先生 Ms. 女士
5.
電話號碼
Telephone No.
6.
傳真號碼
Fax No.
7.
電郵地址
E-mail address
8.
無人駕駛飛機(無人機)種類
Type of Unmanned Aircraft (UA)
airship 飛船 aeroplane 飛機 helicopter 直升機 other type, please specify 其他,請註明:
9.
飛行目的
Purpose of flight
10.
操作手冊(請提供副本 ─ 見註5)
Operations Manual (please provide a copy - see Note 5)
pilot's training 駕駛員訓練 limitations 限制 emergency procedure 緊急程序 others, please specify 其他,請註明:
11.
無人機系統操作員的經驗(見註5)
UAS operation experience of the operator (see Note 5)
12.
緊急降落程序(見註5)
Emergency Landing Procedure (see Note 5)
13.
擬議操作範圍(見註5)
Proposed area(s) of operation (see Note 5)
14.
擬議飛行路線/高度(見註5)
Proposed flight path(s)/altitude(s) (see Note 5)
15.
擬議飛行日期及時間
Proposed date and time of flight(s)
16.
請提供下述無人機系統認證及技術詳情(見註5)。如相關證明文件隨申請表夾附,請選擇“已提交”前的方格;如不夾附,請選擇“不提交”前的方格,並說明原因。
Please provide the following certification and technical details of the UAS (see Note 5). Check the box next to each item if the relevant support document(s) is/are submitted with the application form. If not, please state the reason.
16.1
製造商詳細資料
Manufacturer details
submitted 已提交 not submitted, reason 不提交,原因:
16.2
製造商所在地發出的證明書(如有)
Certificate issued by the state of the manufacturer (if available)
submitted 已提交 not submitted, reason 不提交,原因:
16.3
無人機系統的技術說明/規格,包括設計及建造標準(如有)
Technical descriptions / specifications of the UAS, including the Design & Build Standards (if available)
submitted 已提交 not submitted, reason 不提交,原因:
16.4
無人機系統可靠度的數據
Reliability data of the UAS
submitted 已提交 not submitted, reason 不提交,原因:
16.5
推進系統
Propulsion system
submitted 已提交 not submitted, reason 不提交,原因:
16.6
系統餘度特性
System redundancy features
submitted 已提交 not submitted, reason 不提交,原因:
16.7
自動復元系統
Auto-recovery system
submitted 已提交 not submitted, reason 不提交,原因:
16.8
安全下降
Safe let-down
submitted 已提交 not submitted, reason 不提交,原因:
16.9
無人機大小(長x闊x高,以米為單位)
Dimensions of UA (length x width x height, in metres)
(l) x (w) x (h)
16.10重量(不計燃料)
Weight (without fuel)
kilograms 千克
16.11最大滿載重量
Maximum All Up Weight
kilograms 千克
16.12撞擊能量計算(適用於最大滿載重量為20千克或以上的無人機)
Impact energy calculations (for UA with maximum all up weight of 20 kg or more)
submitted 已提交 not submitted, reason 不提交,原因:
16.13正常操作速度(海里)
Normal operating speed (knot)
16.14最高速度(海里)
Maximum speed (knot)
16.15其他操作限制
Other Operational limitations
wind speed 風速: (knot) 海里 others, please specify 其他,請註明:
16.16續航力
Endurance
submitted 已提交 not submitted, reason 不提交,原因:
16.17有效載重/設備(例如攝影機)
Payload/Equipment (e.g. camera)
submitted 已提交 not submitted, reason 不提交,原因:
16.18維修保養手冊及相關程序
Maintenance Manual and relevant procedures
submitted 已提交 not submitted, reason 不提交,原因:
16.19技術訓練要求、支援及資源
Technical training requirement, support and resources
submitted 已提交 not submitted, reason 不提交,原因:
17.保單所承保第三者責任風險的保額(見註8)
Amount of Third Party Liability Risks covered in Insurance Policy (see Note 8)
HK Dollars 港元
18.有關飛行是否為提供租賃或受酬的服務(見註9)?
Is the flight for hire or reward (see Note 9)?
Yes 是 No 否
附註
NOTES
以下附註為申請人提供填寫表格的指引。
The following Notes are for guidance of the applicant in completing the application form.

1. 請瀏覽民航處網頁連結[ http://www.cad.gov.hk/chinese/Unmanned_Aircraft_Systems.html ]瞭解作非閒暇用途之無人機系統的一般安全操作規範。
1. Please visit the following Civil Aviation Department (CAD) link and take note of the general operational parameters for safe operations of non-recreational UAS [ http://www.cad.gov.hk/english/Unmanned_Aircraft _Systems.html ].

2. 申請表上所有適用空格均須填寫。
2. Information shall be entered in all applicable fields of the application form.

3. 申請人通常是無人機系統操作員或該公司。
3. The applicant is normally the operator of the UAS, or the Company itself.

4. 申請表及所有相關資料須在擬議操作日期前至少28個工作天送達民航處。視乎擬議操作的複雜程度,民航處或需更多時間處理申請。
4. The application form and all relevant information should reach CAD at least 28 working days prior to the date of the proposed flight. Depending on the complexity of the proposed operation, extra time may be required for processing the application.

5. 申請表及證明文件須以電郵[uas@cad.gov.hk]或傳真(2877 8542)方式提交。如以電郵提交,文本檔案須為pdfWord格式,照片檔案須為pdfjpeg格式。如資料不全或不足,申請過程或受阻延。
5. The application form and supporting documents shall be submitted to the following e-mail address [uas@cad.gov.hk] or by fax to 2877 8542. If by e-mail, these documents shall be either in pdf or Word format for text files, and pdf or jpeg format for photo files. Incomplete or insufficient information may delay the application process.

6. 視乎擬議操作的特定情況,申請人或須提供進一步資料或被要求符合其他條件。如對提交申請有任何疑問,請致電(2910 6611)民航處航班事務及安全管理部查詢。
6. Additional information may be required and further conditions may be imposed depending on the particular circumstances of the proposed operation. Any enquiries on the submission should be made to the Air Services and Safety Management Division of CAD on phone no. 2910 6611.

7. 民航處可到場視察,以查證申請人所提交的資料是否屬實,並在有需要時觀看飛行示範。申請人須應民航處要求,安排該等視察及示範。
7. CAD may conduct a site visit to the location to verify the information submitted by the applicant and to witness a demonstration flight, if necessary. The applicant shall make arrangements for such visit and demonstration flight, as required by CAD.

8. 申請人須提供保單副本,證明已就擬議操作為有關操作無人機系統的公司購妥第三者保險。
8. The applicant is required to provide a copy of an insurance policy that appropriately insures the company operating the UAS in respect of third party risks for the proposed operation.

9. 如有關飛行是為提供租賃或受酬的服務,申請人須向民航處提交“使用飛機提供航空服務許可證的申請 - 無人駕駛飛機系統 (無人機系統)”(第DCA 122A號),表格可到 [http://www.cad.gov.hk/application/DCA%20122A.pdf ]下載。
9. If the flight is operated for hire or reward, the applicant is required to submit an Application for Permit for use of aircraft for the provision of air service - Unmanned Aircraft Systems (UAS) (DCA 122A) to CAD which is obtainable at the following site [ http://www.cad.gov.hk/application/DCA%20122A.pdf ].

10. 本申請及所需豁免(如獲豁免)只與《1995年飛航(香港)令》的規定有關。申請人須在進行飛行活動前,遵照任何其他相關法例,向民航處或其他政府部門或機構(視乎何者適用)申請任何其他所需的授權或批准。
10. This application and the requisite Exemption, if granted, only relates to the requirements of the Air Navigation (Hong Kong) Order 1995. The applicant shall obtain any other necessary authorization or permission under any other relevant legislation from CAD, other Government Department(s) or organization(s) as applicable before undertaking the flight.

11. 獲得所需豁免、批淮及/或授權前,申請人不宜承擔任何合約責任。
11. The applicant is advised not to enter into any contractual obligation until the requisite exemptions, permissions and/or authorizations have been obtained.
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Form e-DCA 255 (Apr 2016)