外國人力仲介公司認可申請書
Application Form for Recognition (Recruitment Permit) by Foreign employment service agency
壹、基本資料BASIC INFORMATION 1、申請項目
Applying item
□初次認可 First time
□續予認可 Second time
2、國別 Nationality □泰國THAILAND □菲律賓 PHILIPPINES
□印尼INDONESIA □越南 VIETNAM
□馬來西亞MALAYSIA □蒙古 MONGOLIA
□其他Other:
3、機構編號(初次申請者免填) No. of the Agency (First time applying for recognition, skip to No. 4)
4、機 構名稱 Name of the Agency
英文名稱(務必填寫) Name in English (required)
當地國語文名稱 Name in the mother tongue language
中文名稱(若無中文名
稱者，可免填) Name in Chinese
(without Chinese Name, skip to No. 5)
5、機構負責人姓名(英文) Name of Owner of the Agency (in English)
6、當地國許可或登記字號 No. of permit or Registration Certificate in the home country 7、核發許可或登記之當地國政府
部門(英文)
Issuing Governmental office (in English)
8、當地國許可效期 The validity of the
私業許表P-1 201402
Registration certificate 9、機構地址(英文)
Address of the Agency （in English）
10、機構電話
Telephone number of the Agency 11、機構傳真號碼
Fax number of the Agency 12、電子郵件信箱
E-MAIL Address
貳、申請認可事項 ITEMS APPLYING FOR ROCOGNITION：
※本機構申請中華民國勞動部認可，辦理本國勞工赴中華民國境內工作，願遵
守以下之規定，本公司並知悉如有違反，中華民國勞動部將依「私立就業服
務機構許可及管理辦法」第31 條規定廢止或撤銷認可。
※In consideration of applying to the Republic of China (ROC.) for a license to engage in the exportation of workers to the ROC, I/We hereby certify to abide by the following regulations. If I/We violate any of the regulations, the Ministry Of Labor in the Republic of China will under “Private Employment Service Organization Licensing and Management Regulations” Article 31 abolish or cancel the recognition.
1、 遵守本國及中華民國有關法令規定。
1、 Will abide by all laws and regulations of the home country and the Republic of China.
2、 向勞工收取之費用不得超過該勞工簽署及經本國政府驗證之「外國人入 國工作費用及工資切結書」規定，並遵守本國及中華民國相關收費規定。
2、The fee collected from workers shall not exceed the amount stated in the “ Fees
＆ Salary Declaration for Taiwan-bound Workers,” signed by workers and approved by the R.O.C. representative office and shall follow the related regulations of the worker-sending country and of the R.O.C..
3、 不得授權任何人至中華民國境內從事就業服務工作或主動向雇主發送傳 單、招攬訂單等行為。
3、Will not assign any one as an agency to provide employment service in the Republic of China, issue handbills directly to employers, or to solicit job
the approval of the employer or the cooperating private employment service agency in the ROC, or without the knowledge of them.
5、 不得轉介勞工為其他雇主非法工作。
5、 Shall not arrange the workers for working with illegal employers.
6、 辦理勞工來臺工作已取得中華民國簽證後，若遇勞工不能來臺，應向中
華民國駐當地代表處取消該等勞工之入境簽證，並通知雇主或中華民國 人力仲介業者。
6、 Shall cancel the visas of workers who are unable to come to the ROC with the local ROC representative office and shall notify the employers or the private employment service agencies in the ROC.
7、 不得提供不實資料。
7、 Shall not knowingly provide untruthful or misleading information or statements.
8、 如遇雇主因業務緊縮等因素臨時通知取消或縮減引進人數，應予照辦，
不得超額引進。
8、Shall not export more workers than requested and shall make necessary adjustments to quotas, when informed of full or partial cancellation of the number of workers to be exported due to the reduce of demand etc.
9、 引進之勞工若在中華民國遇有重大事故或死亡，應來臺協助處理善後。
9、Shall make necessary arrangement in the ROC for handling of cases in which workers meet with serious accidents or death.
10、 公司名稱、地址、負責人或負責人姓名變更時，應於30 日內檢附申請書
及有關文件經當地國政府公證及中華民國駐當地國使館驗證後，向本部 申請異動備查。
10、 Shall notify MOL of any change of address, owner or the name of the agency or of the owner with this application form and associated documentation duly notarized by a court or Notary Public in the home country and approved by the local ROC representative office within 30 days after change.
十一、公司終止營業、停業或經撤銷營業執照者，應於10 天內通知中華民國
駐當地國代表處。
11、Shall notify the local ROC representative office of any cessation or suspension or revocation of business certificate within 10 days after the occurrence.
參、申請人applicant：
※以上資料及所附文件均屬實，如有虛偽，願負本國及中華民國法律上之一切 責任。All of the above information and attached documentation are true. If any false, I/we agree to take full responsibility for the laws of the home country and of the Republic of China.
機構名稱:
Name of the Agency
負責人或代表人簽名:
Signature of owner or representative of the agency.
郵寄地址(中華民國以外地址請填寫英文)Mail address (not in the ROC, please fill in English)：
聯絡人 Contact person：
聯絡電話Telephone:( )-
E-MAIL ： 申請日期Date：公元 年 Year 月 Month 日 Day 肆、受委託人the person entrusted by the agency：
□受委託送件至勞動部之中華民國人力仲介公司名稱(中文)或駐華機構：
The name of the private employment service agency or the governmental office of the home country in the ROC who is entrusted with the documentation to submit to Ministry Of Labor
_______________________________________________________________
許可證字號License No.：
聯絡地址Contact address：
聯絡人Contact person：
聯絡電話telephone：( )-
□欲親自領件者請打「v」並加附聲明書
To take the documentation of license and receipt in MOL personally, please
□1.本申請書(私業許表 P-1) Original of this application form。
□2.當地國政府許可從事就業服務業務之許可證或其他相關證明文件影本及 其中譯本。
Copy of the permit of employment service issued by the government in the home country along with Chinese translation version。
□ 3.最近 2 年無違反當地國勞工法令證明文件及其中譯本。
Certificate of clear record on labor related law in the home country within two years along with Chinese translation version。
□4.審查費新臺幣 2,000 元(請購買中華民國之郵局匯票繳交，受款人為「勞動 部勞動力發展署」)
Fee of NT$2,000 (please purchase the postal money order in the post office in t he ROC, the receiver is：勞動部勞動力發展署 （Chinese only）
二、注意事項:前項附件除審查費以外，均需由申請人當地國法院或公證人之公 證，並經中華民國駐當地國代表處驗證。
Note: This application form and associated documentation must be duly notarized by a court or Notary Public in the home country, and approved by the local ROC representative office in that country.
三、經本部認可之外國人力仲介公司，應於認可效期屆滿前3 個月內，檢附「私
立就業服務機構許可及管理辦法」第16 條第 2 項規定之文件，經當地國政
府公證及我國駐當地國使館驗證，並於效期屆滿前 1 個月內向本部申請續
予認可，逾期申請者或不符申請規定經限期補正，屆期未補正者，將不予 認可。
Foreign employment service agencies shall attach the documentation stated in the “Private Employment Service Organization Licensing and Management Regulations ”duly notarized by a court or Notary Public in the home country and approved by the local ROC representative office within 3 months before the expiration of recognition and shall deliver to Ministry of Labor within 1 month before the expiration. MOL will revoke the recognition if the documentation submitted after expiration date or unqualified documentation not amended and submitted within the regulated period of time.
※ 相關法規及申請程序，請依照本部勞動力發展署網站http://www.wda.gov.tw 所載最新規定辦理。
The hottest editions of related regulations and applying procedure are available in the website of Workforce Development Agency,Ministry Of Labor http://www.wda.gov.tw
