编号No中国政府网中央人民政府门户网站.docx

1、编号No中国政府网中央人民政府门户网站编号(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 applicants Board of Directors hereby acknowledges and warrants t

2、hat 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:E

3、nglish: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：Engl

4、ish: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 scopeat 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 la

5、test 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 spe

6、cify.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 Applicants 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)Names and domiciles of major affiliates（please specify all affiliates in Chin

7、a） 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)Name and signature of legal representative or his/her authorized representative of the Applicant (in English if necessary)合格投资者联系人（可用英文）：QFIIs contact person (in English if necessary):电话（Tel）:传真（Fax）:电子邮件（E-mail）:托管人联系人:Custodians contact person电话（Tel）:传真（Fax）

8、:电子邮件（E-mail）: 要求（Requirements）附件（Attachments）齐备性Completeness(是,否)(Yes,No)合规性Authenticity and accuracy(是,否)(Yes,No)备注remarks托管人意见checked by custodian监管部门意见checked by CSRC托管人意见checked by custodian监管部门意见checked by CSRC1、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Letter of Application for QFII（including b

9、ut not limited to company profile, investment strategy, plan and relevant schedule of investment）1.是否由申请人法定代表人签字（whether or not signed by the legal representative of the Applicant） 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(If not, the Power of Attorney issued by the legal representative should be presented)

10、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 (The Notarial Deed, or Legal Opinion issued by a lawyer, or Certification issued by the PRC Embassy in the applicants domicile country should be presented. Please specify)2、申请人授权托管人办理申请事宜的授权委托书The Applicants Letter of Authorization to the Custodian for the

11、 application of QFII3、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 Custodians statement on the applicants qualification according to Provisional Measures on Administration of Domestic Securities Investments of Qualified Foreign Institutional Investors4、与托管人签订的托管协议草案Draft Custody Agreement signed with the Applicants Cu

12、stodian5、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Business License and Financial Business License by authorities at the applicants home jurisdiction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(The Notarial Deed, or Legal Opinion issued by a lawyer, or Certification issued by the PRC Embassy in the applicants domicile co

13、untry should be presented. Please specify)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)Articles of Association and internal control system of the Applicant（Please specify the Articles which permit the applicant to undertake securities trading business and how to control the risks of QFII business

14、） 同5The requirement is the same as specified in Article 5th 7、申请人主要从业人员情况表Name List of the key staff of the Applicant 8、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Statement on any substantial penalties imposed on the Applicant by its home regulator over the recent three years同5The requirement is the same as specifi

15、ed in Article 5th9、资金来源说明书(资金来源合法)Statement on sources of the funds (The applicant should claim that the sources of funds are legal)10、无境内资金和批准时间内不撤资承诺书Letter of commitment claiming no funds from Mainland China and not to withdraw funds during the approved period11、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

16、Audited financial reports for the most recent 3 years and other supporting documents on the Applicants compliance with Article 7 of Provisional Measures12、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If applicable, documents to specify that the applicant or its affiliates have estab

17、lished branches, wholly-owned enterprises and joint ventures, or are engaged in banking, securities and insurance businesses in directly or indirectly prior to the application13、其他(other)监管部门审核人及审核意见Name of the CSRCs reviewing staff and opinions填表说明：申请材料应用牢固的文件夹夹好，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

18、请表中附件顺序装订，并注明序号及题目，不得装入塑料袋。All application materials should be bound by solid-backed folders. Information about the applicant, custodian bank, application date, original paper or copy should be clearly marked on both the front and flank of the folders. The application documents inside should be plac

19、ed in the same sequence as the above attachment requirements and indexed by numbers. Please do not put the sheets into plastic bags or other covers. _QFII主要业务人员（包括业务主管、投资领导、销售领导、法律及合规部主管）大体情形表Form of Personal Information on the Key Staff of QFII(Including Head of QFII Business, Investment Manager, S

20、ales Manager and Head of Legal Affairs and Compliance) 姓 名Full name性 别Gender国籍Nationality2寸正面半身免冠照片Please attach recent photograph x 3.5cm) of the staff. 身份证或护照号码ID or Passport No.出生日期Birthday出生地Place of birth住址Permanent address电子邮件Email address单位及其地址、电话、传真Employer andits address, Tel, Fax主要社会关系（Fam

21、ily members, optional）姓名Name与本人关系Relationship现工作或学习单位Employer or school职 务Title教育简历（从大学开始）Education (Starting from college)起止时间From-to院校College专业Major从业资格及培训情况Professional qualification and training起止时间From-to资格名称或培训内容Qualification or training program组织机构Organizer证 书Certificate工作履历Working Experience起止时间From- to工 作 单 位Employer职 务Title工作内容Responsibility