I 表格:在中華人民共和國(「中國」)註冊成立的發行人的監事的聲明及承諾
Part 1
第一部分
DECLARATION
聲明
第一部分
DECLARATION
聲明
1. | State:– 請填報:
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2. | The relevant document that sets out my personal details in the manner described in paragraph 41(1) of Appendix 1A or rule 13.51(2), as the case may be, of the Rules Governing the Listing of Securities on The Stock Exchange of Hong Kong Limited from time to time in force (the “Listing Rules”) is: 按不時生效的《香港聯合交易所有限公司證券上市規則》(《上市規則》)附錄一A第41(1)段或第13.51(2)條所述方式(視屬何情況而定)載有本人的個人資料的有關文件為: (Tick as appropriate) (請在適當方格內加上√號) In the case of new applicant: 如屬新申請人:
In the case of listed issuer: 如屬上市發行人:
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Part 2
第二部分
UNDERTAKING
承諾
The particulars referred to in this Part 2 are:–
此第二部分所述的資料為:
I, ............................................. [Insert Chinese name, if any]:
本人............................................. [請填上中文姓名(如有)]:
此第二部分所述的資料為:
(a) | in the exercise of my powers and duties as a supervisor of ....................... (Insert the name of the issuer) I, the undersigned, shall:– 在行使 .........................(填入發行人名字)監事的權力及職責時,本人(簽署人)須:
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(b) | I shall, when I am a supervisor of the issuer and after I cease to be so: 本人出任發行人監事時以及停止擔任發行人監事後均須:
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(c) | I, in accepting to be a supervisor of the issuer, hereby irrevocably appoint the issuer as my agent, for so long as I remain a supervisor of the issuer, for receiving on my behalf any correspondence from and/or service of notices and other documents by the Exchange or the Commission; 本人接受出任發行人的監事,即不可撤回地委任發行人為本人的代理人,在本人出任發行人監事期間,代表本人接收任何聯交所或證監會發出的信函及╱或送達的通知書及其他文件; |
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(d) | I shall inform the Exchange (in the manner prescribed by the Exchange from time to time): 本人須在下列情況下(以聯交所不時規定的方式)將下述資料通知聯交所:
I acknowledge and agree that any correspondence from and/or service of notices and other documents by the Exchange or the Commission to me when I am a supervisor of the issuer or after I cease to be so, for whatever purposes (including but not limited to the service of notice of disciplinary proceedings) shall be deemed to have been validly and adequately served on me when the document or notice is served personally or is sent by post, facsimile or email to the address or number I provide to the Exchange. I agree and acknowledge that I am responsible for keeping the Exchange informed of my up-to-date contact details. I acknowledge that, if I, as a supervisor or a former supervisor of the issuer, fail to provide the Exchange with my up-to-date contact details or arrange for notices, documents or correspondence to be forwarded to me, I may not be alerted to any proceedings commenced against me by the Exchange or the Commission; and 本人確認及同意,在本人出任發行人監事期間或不再出任發行人監事之後,但凡聯交所或證監會就任何目的向本人發出的信函及╱或送達的通知書及其他文件(包括但不限於送達紀律程序的通知)若以面交本人的方式,或以郵寄、傳真或電郵的方式送達本人向聯交所提供的地址或號碼,即已有效及充分地送達本人。本人同意及確認,本人有責任向聯交所提供本人最新的聯絡資料。本人確認,若本人(作為發行人的監事或前監事)未能向聯交所提供本人最新的聯絡資料,或未有為送呈本人的通知、文件或書信提供轉送安排,本人可能會不知悉聯交所或證監會向本人展開的任何程序;及 |
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(e) | I, in accepting to be a supervisor of the issuer, hereby authorise the Executive Director - Listing, or any person authorised by the Executive Director – Listing, to disclose any of my personal particulars given by me to members of the Listing Committee or the Commission and, with the approval of the Chairman or a Deputy Chairman of the Exchange, to such other persons, as the Executive Director – Listing may from time to time think fit. 本人接受出任發行人的監事,即授權上巿科執行總監、或其授權的任何人士,將本人提供的個人資料向上巿委員會委員或證監會披露;並在聯交所主席或一位副主席批准的情況下,向上巿科執行總監不時認為適當的其他人士披露。 |
I, ............................................. [Insert Chinese name, if any]:
本人............................................. [請填上中文姓名(如有)]:
(i) | solemnly and sincerely declare that all particulars about me that appear in Part 1(1) of this Form I and in the document referred to in Part 1(2) of this Form I are true, complete and accurate, that I accept responsibility for the truthfulness, accuracy and completeness of the foregoing particulars, that I have not made any statements or omissions which would render such particulars untrue or misleading, that I understand the possible consequences of giving information which is false or misleading in a material particular including those as set forth in the Note hereto, and that I understand that the Exchange may rely upon the foregoing particulars in assessing my suitability to act as a supervisor of the issuer; and 謹以至誠鄭重聲明,在本I表格第一部分(1)及本I表格第一部分(2)所述文件所示有關本人的所有詳細資料均為真實、完整及準確,且本人對上述資料的真實性、準確性及完整性承擔責任,而本人亦無作出任何聲明或遺漏,致使有關資料不真實或具誤導性,本人亦明白在要項上提供虛假或具誤導性的資料可能引致的後果(包括本表格附註所載內容),本人並明白,聯交所或會倚賴上述資料來評估本人是否適合出任發行人監事;及 |
(ii) | undertake with the Exchange in the terms set out in Part 2 of this Form I. 按本 I 表格第二部分所載的條款向聯交所作出承諾。 |
Signature簽署: | ....................... | |
Name of supervisor 監事姓名: |
....................... |
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Hong Kong ID Card Number* 香港身份證號碼*: |
....................... |
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Dated日期: |
....................... |
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Certified as the true signature of ......................... 由以下人士證明上述簽署為...............的真實簽署 |
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By: | ||
Signature (Secretary/Director) 簽署(秘書╱董事): |
....................... |
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Name (Secretary/Director) 姓名(秘書╱董事): |
....................... |
* | In the case of a non-Hong Kong ID cardholder, state the passport number or any identification document number and name of issuing authority. 如為非香港身份證持有人,請列明護照號碼或任何身份識別文件號碼,以及簽發機構名稱。
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