Part A – Particulars

• List out the total number of registered retail outlets covered by the registration during the quarter;
      
• List out the total number of plastic shopping bags provided to customers from any non-exempted area in all registered retail outlets during the quarter; and
   
• State the total amount of levies payable during the quarter.

Part B – Declaration

• Make declaration by signing the “Quarterly Return and Payment” form (Form PSB-5) and stamp the Company Chop; and
  
  
• Fill in the date for the completion of the “Quarterly Return and Payment” form (Form PSB-5) and the telephone number.

Payment instructions

• For payment by cheque, please make sure that the cheque is crossed and payable to the “The Government of the Hong Kong Special Administrative Region”. The payment made should tally with the total amount of levies payable as stated in Part A of the “Quarterly Return and Payment” form (Form PSB-5). Post-dated cheques are not normally accepted;
   
• For payment by PPS, please provide the payment reference number in the space provided; and
   
• For payment through internet, please attach copy of the payment reference for record purpose.

Please click here for a sample of completed “Quarterly Return and Payment” form (Form PSB-5)

Appendix I

• Column 1 - Plastic shopping bags levy registration (retail outlet) number
  
  
  • The PSB Levy Registration Number includes 13 digits – the first nine digits represent “PSB Levy Registration (Retailer) Number” and the last four digits represent “PSB Levy Registration (Retail Outlet) Number”
    . 
    
  • Fill in only the last four digits of the PSB Levy Registration Number.
    
    
• Column A1 - Registration and/or Deregistration date of retail outlet
  
  
  • Leave “blank” if the outlet was not registered or deregistered during the quarter in which the quarterly return is filed; or
    
    
  • Fill in the date on which the retail outlet becomes registered or deregistered during the quarter.  This should be the effective date of registration or deregistration specified in the approval letter issued by EPD.
    
    
• Column A2 - Actual operation dates of retail outlet
  
  
• Leave “blank” if the outlet was not commenced/closed during the quarter in which the quarterly return is filed; or
  
  
• Fill in the first operation date of the new outlet if it is opened (or the first date at which the outlet is covered by the levy scheme) during the quarter in which the quarterly return is filed; and
  
  
• Fill in the last operation date of the outlet if it is closed (or the last date at which the outlet is covered by the levy scheme) during the quarter in which the quarterly return is filed.


• Column B - Number of plastic shopping bags delivered to the retail outlet
  
  
  • Fill in the number of plastic shopping bags delivered to the retail outlets (except for any bags to be provided from an exempted area of the retail outlet that is subject to the criteria for a Type 2 exemption). Fill in a  ‘zero’ if no plastic shopping bag is delivered to the retail outlet(s) during the quarter.
     
• Column C - Number of plastic shopping bags provided to customers from any area of the retail outlet that is not exempted
  
  
  • Fill in the number of plastic shopping bags provided to customers from any area of the retail outlet that is not exempted. Fill in a  ‘zero’ if no plastic shopping bag is provided to the customers from the retail outlet(s) during the quarter and provide a footnote to explain why no plastic shopping bag is provided.
    
    
  • Provide the total amount of levies payable for the plastic shopping bags in the box provided under the bottom part of Column C.