Notice of Appeal to the Torture Claims Appeal Board

(J)Are you accompanied by any members of your family in this appeal?Yes □No □If yes, please provide details:Name Relationship Date of Birth(K)Do you have any special needs (e.g. a signer or an interpreter of the preferredgender)?Yes □(Please specify:)No □Section 2:Appeal(A) Decision being appealed against:I appeal to the Torture Claims Appeal Board against the following decision of animmigration officer (please tick one box only):□ Decision rejecting a torture claim under section 37ZI(1)(b) of the ImmigrationOrdinance.□ Decision not to re-open a torture claim that has been withdrawn under section37ZE(4) or section 37ZG(5) of the Immigration Ordinance.□ Revocation decision under section 37ZL(1) of the Immigration Ordinance.Note: Under section 37ZS(2)(b) of the Immigration Ordinance, this Notice must beaccompanied by a copy of the notice of the decision being appealed against.- 4 -

(B) Grounds of Appeal:You must set out ALL grounds of your appeal. Please give reasons in support of thesegrounds – that is, why you disagree with the decision of the immigration officer beingappealed against. Where appropriate, please refer to the specific paragraphs of theimmigration officer’s written decision. Give as many details as possible. Useadditional sheets of paper if necessary.- 5 -

Section 3: Details of Legal Representative(A)Do you have a legal representative to assist/represent you in lodging this appeal?Yes □ No □ (Go to Section 4)(B)Name of the Representative:(C)Name of the Representative’sLegal Firm (if applicable):(D)Telephone Number:(E)Correspondence Address:(F)Email Address:(G)Fax Number:Section 4: Hearing (if required by the Board)If the Board decides that a hearing will be held to determine your appeal, a hearing will bearranged. The hearing will be held in private unless the Board directs otherwise. A noticeof hearing setting out the date, time and place will be served on you not less than 28 daysbefore the date of hearing 1 .(A)If a hearing is arranged, will you have any witness(es)?Yes □No □If yes, please list details of all witnesses attending the hearing and ask each of them toprepare a witness statement 2 :1 Further information on the hearing procedures can be obtained fromhttp://www.sb.gov.hk/eng/links/tcab/index.htm (“Frequently Asked Questions”).2 The witness statement should include the witness’s full name, address and contact telephone number(s) andset out facts only, not opinions or legal submissions. It should be submitted together with this Notice.- 7 -

Name of Witness Relationship A short description of theevidence to be given(B)Do you or your witness(es) require an interpreter?Yes □(Please specify the language/dialect needed:)No □Section 5:Application for Late Filing of Notice of AppealA person who wishes to appeal against the decision of the immigration officer must file thisNotice within 14 days after notice of such decision is given to him. If you are filing thisNotice after the expiry of the aforesaid 14-day period, you must include below a statementof the reasons for late filing. You must also submit relevant documentary evidence insupport of such reasons.- 8 -

Section 6: Declaration by AppellantI declare that:I verily believe that the information I have supplied on or with this Notice is complete,correct and up-to-date in every detail.I understand that under section 42(1)(a) of the Immigration Ordinance, I may be guiltyof an offence if I make or cause to be made to the Board any statement or representationwhich I know to be false or do not believe to be true.I understand that under section 12 of Schedule 1A of the Immigration Ordinance, theBoard may determine an appeal without a hearing if, having regard to the materialbefore it and the nature of the issues raised, the Board is satisfied that the appeal can bejustly determined without a hearing.I understand that under section 43A of the Immigration Ordinance, I may be guilty of anoffence and be liable to a fine at level 3 and to imprisonment for 6 months if I, withoutreasonable excuse, disrupt the proceedings of the Board.I undertake to promptly inform the Board of any changes of my telephone number andcorrespondence address while my appeal is being processed.Appellant’s signature:Appellant’s Name:Date:Dec 2012- 9 -