[Applicant Name]
[Applicant Address]
[Applicant Email Address]
[Applicant Telephone Number]

Via Fax (+852 2526 4133) & Registered Mail:

Date: [Insert Date]

Hong Kong Immigration Department Ref: [Insert Your File Reference Number]

Chief Secretary for Administration,
Room 321, 3/F, East Wing
Central Government Offices
2 Tim Mei Avenue, Tamar, Hong Kong

Request for Review of a Decision of a Public Offer Under s.53 of the Immigration Ordinance

Dear Madam,

I would respectfully request  a Review of the decision of the Director of Immigration who has recently refused my application for [State Type of Application] on [Date] under the captioned Hong Kong Immigration Department Reference.

I can be contacted at the address and via the details above until further notice.

Yours, most faithfully

[Your Name]