合格境外机构投资者境内证券投资申请表

合格境外机构投资者境内证券投资申请表APPLICATIONFORMFORQUALIFIEDFOREIGNINSTITUTIONALINVESTORS(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:Theapplicant’sBoardofDirectorsherebyrepresentsandwarrantsthatthisApplicationcontainsnofalserepresentations,misleadingstatementsormaterialomissions,andshallbeliableforitsauthenticity,accuracyandcompletenessofthecontents.机构名称(以申请人所在国或地区注册证书为准)NameoftheApplicant（IdenticaltoitsnameinBusinessLicenseatitshomejurisdiction）中文:English:托管人名称NameoftheCustodianBank中文:English:申请额度Investmentquotaapplied机构类别Institutioncategory基金管理机构Fundmanagementinstitution保险公司Insurancecompany证券公司Securitiescompany商业银行Commercialbank其他机构(请说明)Otherinstitution（pleasespecify）成立时间Timeofestablishment注册地址Domicileofincorporation中文：English:所在国家或地区注册证书号BusinessLicenseNo.athomejurisdiction所在国家或地区资产管理业务许可证号AssetManagementCertificateNo.athomejurisdiction所在国家或地区经核准的业务范围Approvedbusinessscopeathomejurisdiction开始经营金融业务的时间、地点和业务类型Commencingdate,locationandcategoryforfinancialbusiness上一会计年度实收资本Paid-incapitalinthelatestaccountingyear最近一个会计年度管理的证券资产规模Assetsundermanagementinthelatestaccountingyear同行业排名Rankintheindustry所在国或地区监管机构名称Nameofthehomeregulatoryauthority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Hastheapplicantbeenpenalizedbyitshomeregulatorinrecent3years?Ifyes,pleasespecify.从业人员符合所在国家或地区从业资格要求的情况ProfessionalqualificationsstatusoftheApplicant’semployees主要股东名称、注册地、股权比例（可用英文）Names,domicileandpercentageofholdingofmajorshareholders(inEnglishifnecessary)主要关联机构的名称、注册地(境内关联机构应详尽)Namesanddomicilesofmajoraffiliates（plsspecifyallofaffiliatesinChina）中文：English:申请人法定代表人或其授权代表姓名及其签名(可用英文)Nameandsignatureoflegalrepresentativeorhis/herauthorizedrepresentativeoftheApplicant(inEnglishifnecessary)合格投资者联系人（可用英文）：QFII’scontactperson(inEnglishifnecessary):电话：Tel:传真：Fax:电子邮件：E-mail:托管人联系人:Custodian’scontactperson电话（Tel）传真（Fax）电子邮件（E-mail）要求（Requirements）附件（Attatchments）齐备性Completeness(是√,否×)(Yes√,No×)合规性Authenticityandaccuracy(是√,否×)(Yes√,No×)备注remarks托管人意见checkedbycustody监管部门意见checkedbyCSRC托管人意见checkedbycustody监管部门意见checkedbyCSRC1、合格投资者申请书(包括但不限于申请人基本情况、投资理念、投资计划及有关的工作进度LetterofApplicationforQFII（includingbutnotlimitedtocompanyprofile,philosophyofinvestment,planandrelevantscheduleofinvestment）1.是否由申请人法定代表人签字（whetherornotsignedbythelegalrepresentativeoftheapplicant）2.若由法定代表人的授权代表签署，应当出具该法定代表人的授权委托书(ifnot,thePowerofAttorneyissuedbythelegalrepresentativeshouldbepresented)3.该授权委托书须经公证，或律师出具法律意见书，或经中华人民共和国驻该国的使、领馆认证(TheNotarialDeed,orLegalOpinionissuedbylawyer,orCertificationissuedbythePRCEmbassyintheapplicant’sdomicilecountryshouldbepresented.Plsspecify)2、申请人授权托管人办理申请事宜的授权委托书TheApplicant’sLetterofAuthorizationtotheCustodianfortheapplicationofQFII3、托管人对申请人是否符合《暂行办法》规定的资格条件的证明Custodian’sstatementontheapplicant’squalificationaccordingtoProvisionalMeasuresonAdministrationofDomesticSecuritiesInvestmentsofQualifiedForeignInstitutionalInvestors4、与托管人签订的托管协议草案DraftCustodyAgreementsignedwiththeApplicant’sCustodian5、申请人所在国或者地区主管部门核发的营业执照和金融业务许可证BusinessLicenseandFinancialBusinessLicensebyauthoritiesattheapplicant’shomejurisdiction须经公证，或律师出具法律意见书，或经中华人民共和国驻该国的使、领馆认证(TheNotarialDeed,orLegalOpinionissuedbylawyer,orCertificationissuedbythePRCEmbassyintheapplicant’sdomicilecountryshouldbepresented.Plsspecify)6、申请人的公司章程和内部控制制度(注明允许申请人从事证券交易活动的条款和QFII风险控制条款)ArticlesofAssociationandinternalcontrolsystemoftheapplicant（PlsspecifythearticleswhichpermittheapplicanttoundertakesecuritiestradingbusinessandhowtocontroltherisksofQFIIbusiness）同5Therequirementisthesameasspecifiedinarticle5th7、申请人主要从业人员情况表IntroductionListofthekeystaffofapplicant8、申请人最近3年是否受到所在国家或地区监管机构处罚的说明Statementonanysubstantialpenaltiesimposedontheapplicantbyitshomeregulatorovertherecentthreeyears同5Therequirementisthesameasspecifiedinarticle5th9、资金来源说明书(资金来源合法)Statementonsourcesofthefunds(Theapplicantshouldclaimthatthesourcesoffundsarelegal)10、无境内资金和批准时间内不撤资承诺书LetterofcommitmentclaimingnofundsfromMainlandChinaandnottowithdrawfundsduringtheapprovedperiod11、最近三年经审计的财务报表和其他证明申请人符合《暂行办法》第七条规定的文件Auditedfinancialreportsforthemostrecent3yearsandothersupportingdocumentsontheapplicant’scompliancewithArticle7ofProvisionalMeasures12、申请人或其关联方如在申请前已在中国境内设有分支机构、独资或合资企业，直接或者间接开展银行、证券及保险业务活动的，应当详细说明Ifapplicable,documentstospecifythattheapplicantoritsaffiliateshaveestablishedbranches,wholly-ownedenterprisesandjointventures,orareengagedinbanking,securitiesandinsurancebusinessesinP.R.C.directlyorindirectlypriortotheapplication13、其他(other)监管部门审核人及审核意见ApprovalornotbythestaffofCSRC填表说明：申请材料应用坚固的文件夹夹好，正面、侧面须注明申请人、托管人、申请日期、原件(副件)，有关文件应按申请表中附件顺序装订，并注明序号及标题，不得装入塑料袋。Allapplicationmaterialsshouldbeboundbysolid-backedfolder.Clearinformationaboutapplicant,custodianbank,applicationdate,originalorcopyshouldallbedemonstratedonboththefrontandspineofthefolders.Theapplicationdocumentsinsideshouldbeplacedinthesamesequenceastheaboveattachmentrequirementandindexedbynumber.Donotputthesheetsintoplasticbagorotherclearcover.____________QFII