PDF《Harbin Bank Co., Ltd. *》

declaration I/We agree to the terms and conditions and application procedures in this Application Form and the Prospectus. Please refer to the Effect of completing and submitting this Application Form section of this Application Form. Warning: Only one application may be made for the bene?t of any person. Please refer to the last four bullets of Effect of completing and submitting this Application Form section. 致: 哈尔滨银行股份有限公司 联席全球协调人 联席账簿管理人 香港承销商 申请人声明 本人吾等同意本申请表格及招股书的条款及条件 以及申请程序.请参阅本申请表格 「填交本申请表格 的效用」 一节. 警告:任何人士只限作出一次为其利益而进行的认 购申请.请参阅 「填交本申请表格的效用」 一节最后 四点. ? * For identi?cation purposes only. * 仅供识别. ** Harbin Bank Co., Ltd. is not an authorized institution within the meaning of the Banking Ordinance (Chapter

155 of Laws of Hong Kong), not subject to the supervision of the Hong Kong Monetary Authority, and not authorized to carry on banking/deposit-taking business in Hong Kong. ** 哈尔滨银行股份有限公司根愀鄯155章银行业条例并非一家认可机构,不受香港金融管理局监督,亦不获授权在 香港经营银行存款业务. Staple your payment here 请将股款 紧钉在此 Please use this form if you want the Hong Kong Offer Shares to be issued in your name 如 阁下欲以本身名义登记将获发行的香港发售股份,请使用本表格 Signed by (all) applicant(s) (all joint applicants must sign): 由 (所有) 申请人签署 (所有联名申请人必须签署) : Date: 日期: / / D 日M月Y年Number of Hong Kong Offer Shares applied for (not more than 151,179,000 shares) 申请香港发售股份数目 (不超过151,179,000股股份) Total amount 总额 HK$ 港元 Name in English 英文姓名名称 For Broker use 此栏供经纪填写 Lodged by 递交申请的经纪 Broker No. 经纪号码 Broker'

s Chop 经纪印章 Cheque/banker'

s cashier order number 支票银行本 票号码 Name of bank on which cheque/Banker'

s cashier order is drawn (see How to make your application section) 兑现支票银行本票的银行名称 (见 「申请手续」 一节) Family name or company name 姓氏或公司名称 Forename(s) 名字 Name in Chinese 中文姓名名称 Family name or company name 姓氏或公司名称 Forename(s) 名字 Occupation in English 职业 (以英文填写) Names of all other joint applicants in English (if any) 所有其他联名申请人的英文姓名名称 (如有) 1) 2) 3) Hong Kong Identity Card No./Passport No./Hong Kong Business Registration No.* (Please delete as appropriate) 香港身份证号码护 照号码香港商业登记号码*(请删除不适用者) Hong Kong Identity Card No./Passport No./Hong Kong Business Registration No. of all other joint applicants* (Please delete as appropriate) 所有其他联名申请人的香港身份证号码护照号码 香港商业登记号码*(请删除不适用者) 1) 2) 3) Hong Kong address in English and telephone no. (joint applicants should give the address and the telephone number of ?rst-named applicant only) 香港地址 (以英文填写) 及电话号码 (联名申请人只须填写排名首位申请人的地址及电话号码) Telephone No. 电话号码 For Nominees: You will be treated as applying for your own bene?t if you do not complete this section. Please provide an account number or identi?cation code for each (joint) bene?cial owner. 由代名人递交:代名人若不填写本节,则是项认购 申请将视作为 阁下本身利益提出.请填写每名 (联名) 实 益拥有人的账户号码或识别编码. ADDRESS LABEL 地址标贴 (Your name(s) and address in Hong Kong in BLOCK letters 请用正楷填写姓名名称及香 港地址) For Internal use 此栏供内部使用 Please use this form if you want the Hong Kong Offer Shares to be issued in your name 如 阁下欲以本身名义登记将获发行的香港发售股份,请使用本表格 * (1) An individual must provide his Hong Kong Identity Card number or, if he does not hold a Hong Kong Identity Card, his passport number. A body corporate must provide its Hong Kong Business Registration number. Each joint applicant must provide its or his relevant number. The Hong Kong Identity Card number(s)/passport number(s)/Hong Kong Business Registration number(s) will be transferred to a third party for checking the Application Form'