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编号(No): 合格境外机构投资者境内证券投资申请表 APPLICATION FORM FOR QUALIFIED FOREIGN INSTITUTIONAL INVESTORS (QFIIs) 致： To: 申请人： Applicant： 申请日期(Date)： __ 重要声明：本申请人董事会保证本申请所载材料不存在任何虚假记载、误导性陈述或者重大遗漏，并对内容的真实性、准确性和完整性承担法律责任。 Acknowledgement: The applicant’s Board of Directors hereby acknowledges and warrants that this application contains no false representations, misleading statements or material omissions, and shall be liable for the authenticity, accuracy and completeness of the contents. 机构名称(以申请人所在国或地区注册证书为准) Name of the Applicant（Identical to its name in Business License at its home jurisdiction） 中文: English: 托管人名称 Name of the Custodian Bank 中文: English: 申请额度 Investment quota applied 机构类别 Institution category 基金管理机构 Fund management institution 保险公司 Insurance company 证券公司 Securities company 商业银行 Commercial bank 其他机构(请说明) Other institution（please specify） 成立时间 Time of establishment 注册地址 Domicile of incorporation 中文： English: 所在国家或地区注册证书号 Business License No. at home jurisdiction 所在国家或地区资产管理业务许可证号 Asset Management Certificate No. at home jurisdiction 所在国家或地区经核准的业务范围 Approved business scope at home jurisdiction 开始经营金融业务的时间、地点和业务类型 Commencing date, location and category for financial business 上一会计年度实收资本 Paid-in capital in the latest accounting year 最近一个会计年度管理的证券资产规模 Assets under management in the latest accounting year 同行业排名 Ranking in the industry 所在国或地区监管机构名称 Name of the home regulatory authority 中文： English: 近三年内是否受到所在国家或地区监管机构的处罚。如有，请说明 Has the applicant been penalized by its home regulator in recent 3 years? If yes, please specify. 从业人员符合所在国家或地区从业资格要求的情况 Professional qualifications status of the Applicant’s employees 主要股东名称、注册地、股权比例（可用英文） Names, domicile and percentage of holding of major shareholders (in English if necessary) 主要关联机构的名称、注册地(境内关联机构应详尽