1.

State:– 请填报：     in English 英文 in Chinese 中文 (a) present surname and any former surname(s)* 现时姓氏及任何前度姓氏* ...................... ...................... (b) alias, if any * 别名，如有* ...................... ..................... (c) present forename(s) and any former forename(s) * 现时名字及任何前度名字* ...................... ..................... (d) date of birth 出生日期 ...................... ..................... (e) residential address 住址 ...................... ..................... (f) nationality and former nationality, if any 国籍及前度国籍，如有 ...................... ..................... (g) (i) Hong Kong ID card number 香港身份证号码 (ii) in the case of a non-Hong Kong ID cardholder, passport number or any identification document number and name of issuing authority 如为非香港身份证持有人，请列明护照号码或任何身份识别文件号码，以及签发机构名称 ...................... .. .................... ..................... ..................... (h) name of issuer (i.e. the new applicant/listed issuer) 发行人（新申请人╱上市发行人）名称 ..................... ..................... * As set out in the Hong Kong ID card, or any relevant identification document referred to in 1(g) above. * 香港身份证或上文1(g) 所述的任何有关身份识别文件上所示者。

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: 按不时生效的《香港联合交易所有限公司证券上市规则》（《上市规则》）附录一A第41(1)段或第13.51(2)条所述方式（视属何情况而定）载有本人的个人资料的有关文件为： (Tick as appropriate) (请在适当方格内加上√号） In the case of new applicant: 如属新申请人： □ the listing document dated ........................... which has been duly registered with the Companies Registry. 日期为............年............月.........日并已正式在公司注册处登记的上市文件。 In the case of listed issuer: 如属上市发行人： □ the announcement dated ........................... by the issuer as required under Listing Rule 13.51(2) with regard to my appointment as a supervisor of the issuer. 发行人按《上市规则》第13.51(2)条的规定，就委任本人为发行人监事的公告。公告日期为...............年...............月...............日。

Part 2
第二部分

UNDERTAKING
承诺

The particulars referred to in this Part 2 are:–
此第二部分所述的资料为：

(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 .........................（填入发行人名字）监事的权力及职责时，本人（签署人）须： (i) comply to the best of my ability with all applicable laws, rules, regulations and normative statements from time to time in force in the PRC relating to the responsibilities, duties and obligations of a supervisor in connection with the governing, operation, conduct or regulation of public companies in the PRC or elsewhere; 尽力遵守不时生效的所有关于监事对中国或其他地方的公众公司的管辖、运作、行为或监管的责任、职责及义务的适用中国法律、规则、规例及规范声明；   (ii) comply to the best of my ability with the provisions of the issuer s articles of association (including all provisions regarding the duties of supervisors) and cause the issuer and its directors to act at all times in accordance with the issuer s articles of association; 尽力遵守发行人的公司章程的规定（包括有关监事职责的一切规定），并促使发行人及其董事在任何时候均按照发行人的公司章程而行事；   (iii) use my best endeavours to cause the issuer and its directors to comply with the Rules Governing the Listing of Securities on The Stock Exchange of Hong Kong Limited from time to time in force (the “Listing Rules”), the Code on Takeovers and Mergers, the Code on Share Buy-backs and all other relevant securities laws and regulations from time to time in force in Hong Kong; 尽力促使发行人及其董事遵守不时生效的《香港联合交易所有限公司证券上巿规则》（《上巿规则》）、《公司收购及合并守则》、《公司股份回购守则》及香港所有其他不时生效的有关证券的法例及规例；   (iv) inform The Stock Exchange of Hong Kong Limited forthwith and in writing, at any time while I am a supervisor of the issuer, of the initiation by the issuer s supervisory committee of legal proceedings against any director of the issuer; 在本人担任发行人的监事的任何期间，如发行人的监事会对发行人的任何董事提出法律程序，立即通知及以书面通知香港联合交易所有限公司；   (v) comply to the best of my ability, as if the same applied to me to the same extent as it does to directors of the issuer, with: (a) Parts XIVA and XV of the Securities and Futures Ordinance; (b) the Model Code for Securities Transactions by Directors of Listed Issuers set out in Appendix 10 of the Listing Rules; (c) the Code on Takeovers and Mergers; (d) the Code on Share Buy-backs; and (e) all other relevant securities laws and regulations from time to time in force in Hong Kong; 尽力遵守下列条例及规则，犹如该条例适用于本人，如同其适用于公司董事般：(a)《证券及期货条例》第XIVA及XV部；(b)《上巿规则》附录十列出的《上巿发行人董事进行证券交易的标准守则》；(c)《公司收购及合并守则》；(d)《公司股份回购守则》；以及(e)香港所有其他不时生效的有关证券法例与规例；   (vi) use my best endeavours to procure that any alternate of mine shall so comply; 尽力促使本人的任何替任人遵守上述各项；
(b)	I 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 Stock Exchange of Hong Kong Limited; 本人兹不可撤回地委任发行人为本人的代理人，在本人留任发行人监事期间，代表本人接收香港联合交易所有限公司发出的任何书信及 / 或送达的通知书及其他文件；
(c)	I shall provide to The Stock Exchange of Hong Kong Limited, immediately upon my resignation as a supervisor of the issuer, my up-to-date contact information, including my address for correspondence from and service of notices and other documents by The Stock Exchange of Hong Kong Limited and telephone number; and 本人将在辞去发行人监事职务后，立即向香港联合交易所有限公司提供本人最新的联络资料，包括供本人接收香港联合交易所有限公司发出的书信、送达的通知书及其他文件的地址和电话号码；以及
(d)	I hereby give my authority to the Head of the Listing Division of The Stock Exchange of Hong Kong Limited, or to any person authorised by him, to disclose any of the foregoing particulars given by me to members of the Listing Committee and, with the approval of the Chairman or a Deputy Chairman of The Stock Exchange of Hong Kong Limited, to such other persons, as the said Head of the Listing Division may from time to time think fit. 本人兹授权香港联合交易所有限公司上巿科主管、或其授权的任何人士，将本人提供的上述资料向上巿委员会委员披露；并在香港联合交易所有限公司主席或一位副主席批准的情况下，向上巿科主管不时认为适当的其他人士披露。

I, ............................................. [Insert Chinese name, if any]:
本人............................................. [请填上中文姓名（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 Stock Exchange of Hong Kong Limited may rely upon the foregoing particulars in assessing my suitability to act as a supervisor of the issuer; and 谨以至诚郑重声明，在本I表格第一部分(1)及本I表格第一部分(2)所述文件所示有关本人的所有详细资料均为真实、完整及准确，且本人对上述资料的真实性、准确性及完整性承担责任，而本人亦无作出任何声明或遗漏，致使有关资料不真实或具误导性，本人亦明白在要项上提供虚假或具误导性的资料可能引致的后果（包括本表格附注所载内容），本人并明白，香港联合交易所有限公司或会倚赖上述资料来评估本人是否适合出任发行人监事；及

(ii)

undertake with The Stock Exchange of Hong Kong Limited in the terms set out in Part 2 of this Form I. 按本 I 表格第二部分所载的条款向香港联合交易所有限公司作出承诺。

	Signature签署：	.......................
	Name of supervisor 监事姓名：	.......................
	Hong Kong ID Card Number* 香港身份证号码*：	.......................
	Dated日期：	.......................
	Certified as the true signature of ......................... 由以下人士证明上述签署为...............的真实签署
	By:
	Signature (Secretary/Director) 签署（秘书╱董事）：	.......................
	Name (Secretary/Director) 姓名（秘书╱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. 如为非香港身份证持有人，请列明护照号码或任何身份识别文件号码，以及签发机构名称。 Note: 附注： The failure of any person required to lodge this Form I to complete Part 1 of this Form I truthfully, completely and accurately, or the failure to execute Part 2 of this Form I or to observe any of the undertakings made under that Part, constitutes a breach of the Listing Rules. In addition, every supervisor of the issuer supplying information sought or referred to in this Form I, should note that such information constitutes information which is provided to the Exchange in purported compliance with a requirement to provide information under the “relevant provisions” (as defined in Part 1 of Schedule 1 to the Securities and Futures Ordinance, Cap. 571) and is likely to be relied upon by the Exchange. In relation to this, you should be aware that giving to the Exchange any information which is false or misleading in a material particular will render the relevant person liable for prosecution for an offence under section 384 of the Securities and Futures Ordinance. If you have any queries you should consult the Exchange or your professional adviser immediately. 按规定须呈交本I表格的任何人士，若未能真实、完整及准确地填妥本I表格第一部分，或未能签立本I表格第二部分又或未能遵守该部分所作的任何承诺，均构成违反《上市规则》。此外，凡提供本I表格所要求或所述资料的发行人监事均应注意，该等资料构成本意是为遵守「有关条文」（定义见香港法例第571章《证券及期货条例》附表1第1部）项下关于提供资料的规定而向本交易所提供的资料，本交易所或会依赖该等资料。就此，　阁下应注意，根据《证券及期货条例》第384条，在要项上向本交易所提供虚假或具误导性的资料，有关人士即属犯法，会遭检控。若　阁下有任何疑问，应立即谘询本交易所或　阁下的专业顾问。