綜合投資開戶申請表 ( 個人或聯名帳戶 ) All-In-One Investment Application Form (Individual/Joint Account)

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1 綜合投資開戶申請表 ( 個人或聯名帳戶 ) All-In-One Investment Application Form (Individual/Joint Account)

2 SECTION A - CLIENT INFORMATION STATEMENT 客戶資料聲明 Application for 申請帳戶 Type of Account ( Please any services as required)) 帳戶種類 ( 請以 號選擇客戶所需服務 ) : Individual Account 個人帳戶 HK Securities Cash Account 香港證券現金帳戶 HK Securities Margin Account 香港證券保證金帳戶 Global Securities Margin Account 環球證券保證金帳戶 Futures Account (HK & Global) 期貨帳戶 ( 香港及環球 ) Joint Account 聯名帳戶 Account no 戶口號碼 : Account no. 戶口號碼 : Account no. 戶口號碼 : Account no. 戶口號碼 : Primary Account Holder 主要帳戶持有人 Client Name 客戶姓名 Mr. 先生 Ms. 女士 Mrs. 太太 Miss 小姐 * 刪去不適用者 Delete inappropriate Chinese 中文 : *I.D. Card/Passport No. 身份證或護照號碼 : Issuing Country 簽發國家 : Date of Birth(DD/MM/YY) 出生日期 : English 英文 : Gender 性別 : Male 男 Female 女 Nationality 國籍 : Marital Status (optional) 婚姻狀況 ( 可選擇性地填寫 ): Single 單身 Married 已婚 Residential Address (PO Box is not acceptable) 住宅地址 ( 不接受郵政信箱 ) : 通訊地址 Corrspondence Address: Job Title 職位 : Year(s) of Service 服務年資 : Name of Company 公司名稱 : Nature of Business 業務性質 : Listed Company 上市公司 : Yes 是 No 不是 Office Address 辦公室地址 : Home Telephone No. 住宅電話 : Mobile No. 手提電話 : Office Telephone No. 辦公室電話 : Fax No. 傳真 : Statements / Contract Notes to be sent to (please select one option only) 交易結算單 / 買賣單據寄往 ( 請只選擇其中一項 ): Address 電郵地址 : Home Address 住宅地址 (HK$30) Corrspondence Address 通訊地址 (HK$30) Office Address 辦公室地址 (HK$30) Unless otherwise instructed by you, all monies made payable to you will be credited to the following bank account (FPS Client must designate a bank account) 除經客戶另行指示外, 須付予客戶的款項將會被轉入下列銀行帳戶 ( 富泰中順客戶必須指定一個銀行帳戶 ) Bank Name 銀行名稱 : Designated Bank Name 指定入賬銀行名稱 Bank Account Currency / Number 銀行帳戶貨幣 / 號碼 HKD A/C 港元 / USD A/C 美元帳戶號碼 : Additional Bank Name (Optional) 備用入帳銀行名稱 ( 如適用 ) HKD A/C 港元 / USD A/C 美元帳戶號碼 : Bank Account Holder's Name (name(s) shown on bank statements should correspond to this Form) 帳戶持有人名稱 ( 須與客戶的銀行結單及此表格上的名稱相符 ) If the bank account is outside Hong Kong, please state the location and SWIFT code (if applicable) 若為香港以外銀行帳戶, 請提供地區及編號 ( 若適用者 )

3 Joint Client 聯名帳戶持有人 Client Name 客戶姓名 Mr. 先生 Ms. 女士 Mrs. 太太 Miss 小姐 * 刪去不適用者 Delete inappropriate Chinese 中文 : *I.D. Card/Passport No. 身份證或護照號碼 : Issuing Country 簽發國家 : Date of Birth(DD/MM/YY) 出生日期 : Residential Address (PO Box is not acceptable) 住宅地址 ( 不接受郵政信箱 ) : English 英文 : Gender 性別 : Male 男 Female 女 Nationality 國籍 : Marital Status (optional) 婚姻狀況 ( 可選擇性地填寫 ): Single 單身 Married 已婚 通訊地址 Corrspondence Address: Job Title 職位 : Year(s) of Service 服務年資 : Name of Company 公司名稱 : Nature of Business 業務性質 : Listed Company 上市公司 : Yes 是 No 不是 Office Address 辦公室地址 : Home Telephone No. 住宅電話 : Mobile No. 手提電話 : Office Telephone No. 辦公室電話 : Fax No. 傳真 : Financial information 財務資料 : Residence 住屋 SECTION B CLIENT FINANCIAL PROFILE 客戶財務概況 Owned 自置 Rented 租住 Mortgage Outstanding 剩餘按揭 HK$ Monthly mortgage payments 每月供款 HK$ Monthly rental payment 每月租金支出 HK$ Estimated Net Worth 凈資產值 <HK$1,000,000 HK$1,000,000 HK$2,000,000 HK$2,000,000 HK$5,000,000 HK$5,000,000- HK$10,000,000 >HK$10,000,000 Liquid Assets 流動產值 <HK$50,000 HK$50,001 HK$200,000 HK$200,001 HK$500,000 HK$500,001- HK$1,000,000 >HK$1,000,000 Annual Income 年收入 <HK$100,000 HK$100,001 HK$300,000 HK$300,001 HK$500,000 HK$500,001- HK$1,000,000 >HK$1,000,000 Source of fund ( 資金來源 ): You can choose more than 1 option ( 可選擇多於一項 ): Income from Earnings 工作收入 Investment Proceeds 投資收益 Gift 餽贈 Sale of business 商業買賣收益 Inheritance 遺產繼承 Legal Settlement 訴訟收益 Pension/retirement Savings 退休金 Spouse/parent 配偶 / 父母 Lottery/Gaming 賭博 Insurance Proceeds 保險收益 Others (please specify) 其他 ( 請註明 ):

4 Relevant Investment Experience 相關投資經驗 : HK listed Securities 香港上市證券 <1 Year 年 1-3 Year(s) 年 3-5 Years 年 5-10 Years 年 > 10 Years 年 Overseas listed Securities 海外上市證券 <1 Year 年 1-3 Year(s) 年 3-5 Years 年 5-10 Years 年 > 10 Years 年 HK futures and options 香港期貨及期權 <1 Year 年 1-3 Year(s) 年 3-5 Years 年 5-10 Years 年 > 10 Years 年 Overseas futures and options 海外期貨及期權 <1 Year 年 1-3 Year(s) 年 3-5 Years 年 5-10 Years 年 > 10 Years 年 Investment objectives and risk tolerance 投資目的及可承受風險 : (a) Investment objectives 投資目的 Income 收入 Hedging 對沖 Capital Gain 資本增值 Speculation 投機 (b) Risk tolerance 可承受風險 Low 低風險 Medium 中等風險 High 高風險 Securities Margin is classified as Medium Risk and/or High Risk category. 證券保證金買賣帳戶屬於 " 中等風險 " 及 / 或 " 高風險 " 類別 Futures Account is classified as Medium Risk and/or High Risk category. 期貨買賣帳戶屬於 " 中等風險 " 及 / 或 " 高風險 " 類別 (c) Anticipated number of trades per month? 預計每月交易次數? Anticipated number of trade volume per month? 預計每月交易總額? HK$ SECTION C IDENTITY DECLARATION 身份聲明 (a) Are you, either alone or with your spouse, in control of 35% or more of the voting rights of any corporate client of FPS? 客戶是否個人或與客戶的配偶共同控制任何富泰中順的公司客戶 35% 或以上的投票權? Yes 是 (please specify 請註明 ) No 不是 (b) Is your spouse, parent and/or children a client of FPS? 客戶的配偶, 父母, 及 / 或子女是否富泰中順的客戶? Yes, whose name is 是, 其姓名為 No 不是 (c) Are you, your spouse, parent and/or children, a director and/or shareholder of a corporate client of FPS? 客戶自己, 其配偶, 父母, 及 / 或子女是否富泰中順的公司帳戶的董事及 / 或股東? Yes, please specify 是, 詳情為 No 不是 (d) Are you related to any FPS employee? 客戶是否與富泰中順任何僱員有親屬關係? Yes, such employee's name is 是, 僱員姓名為 No 不是 (e) Are you an employee of a entity licensed or registered with the Hong Kong Securities and Futures Commission? 客戶是否香港證監會持牌人或註冊人的僱員? Yes, details are 是, 詳情為 : CE No. No 不是 (f) Are you the Ultimate Beneficial Owner(s) of this account? 客戶是否此帳戶之最終受益人? Yes 是 No, please provide UBO s name & ID/passport no. 不是, 請提供最終受益人的姓名及身份證或護照號碼 :

5 SECTION D - ASSESS A CLIENT S KNOWLEDGE OF DERIVATIVES 評估客戶對衍生工具的認識 1. I/We have executed five or more transactions in derivative products (whether traded on an exchange or not), e.g. Derivative Warrants, Callable Bull/Bear Contracts, Stock Options, Futures, Commodities, Structured Products and ETFs, etc. within the past three years. 本人 / 吾等於過去三年, 曾執行五次或以上有關衍生產品 ( 不論是否在交易所買賣 ) 的交易, 例如 : 衍生權證 牛熊證 股票期權 期貨 商品 結構性產品及交易所買賣基金等 2. I/We have current or previous working experience related to derivative products. 本人 / 吾等於現時或過去擁有與衍生產品有關的工作經驗 職位 Position.. 公司名稱 Company name.. 工作年期 Year(s)of working experience: 有關工作經驗詳情 experience details.. 3. I /We have undergone relevant training or attended relevant courses on derivative products. 本人 / 吾等曾接受有關衍生產品的培訓或修讀相關課程 請提供詳情 Please provide details.. 4. I/We acknowledge that I/we have read and fully understood the document entitled Risk Disclosure Statement or Explanation of Risks Associated with Exchange-Traded Derivative Products provided by FPS in a language of my/our choice (English or Chinese). I/We am/are willing to accept the risks associated with trading derivative products. 本人 / 吾等確認已仔細閱讀及完全明白, 由富泰中順提供, 並以本人 / 吾等所選擇之語言 ( 英文或中文 ) 的 風險披露聲明或就在交易所買賣的衍生產品所附帶的風險作出解釋 本人 / 我們並願意承擔交易相關衍生產品所帶來的潛在風險 Client Declaration 客户聲明 本人 / 吾等謹此聲明本人 / 吾等已符合如上所示之上述評估條件並已提供相關資料 : 條件 (1) 或 (2) 或 (3) 或 (4) I/We hereby declare that I/we have fulfilled the above-mentioned assessment criterion/criteria as indicated above and provided the relevant information: Condition(1)or(2)or(3)or(4) 簽署人姓名 Signatory Name(s) : 主要帳戶人 : 聯名帳戶人 : 主要帳戶人簽名 Primary Account Holder Signature 聯名帳戶人簽名 Joint Client Signature 簽署日期 Date :

6 SECTION E W-8BEN 外國身份受益人免扣繳美國所得稅聲明書 form W-8BEN (Rev. February 2014) Department of the Treasury Internal Revenue Service Do NOT use this form if: Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) For use by individuals. Entities must use Form W-8BEN-E. Information about Form W-8BEN and its separate instructions is at Give this form to the withholding agent or payer. Do not send to the IRS. OMB No Instead, use Form: You are NOT an individual... W-8BEN-E You are a U.S. citizen or other U.S. person, including a resident alien individual... W-9 You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S. (other than personal services).... W-8ECI You are a beneficial owner who is receiving compensation for personal services performed in the United States or W-4 A person acting as an intermediary... W-8IMY Part I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial owner 2 Country of citizenship 3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address. City or town, state or province. Include postal code where appropriate. Country 4 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country 5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions) 7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions) Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 I certify that the beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. 10 Special rates and conditions (if applicable-see instructions): The beneficial owner is claiming the provisions of Artic le: of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income): Explain the reasons the beneficial owner meets the terms of the treaty article: Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that: I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself as an individual that is an owner or account holder of a foreign financial institution, The person named on line 1 of this form is not a U.S. person, The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is not subject to tax under an applicable income tax treaty, or (c) the partner s share of a partnership's effectively connected income, The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country, and For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect. Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) Print name of signer Capacity in which acting (if form is not signed by beneficial owner) For Paperwork Reduction Act Notice, see separate instructions. Cat. No Z Form W-8BEN (Rev )

7 富泰中順證券期貨有限公司為一間核准從事證券及期貨條例 ( 香港法例第五 七一章 ) 中第一類 ( 證券交易 ), 第二類 ( 期貨合約交易 ), 第四類 ( 就證券 提供意見 ) 及第五類 ( 就期貨合約提供意見 ) 及第九類 ( 提供資產管理 ) 受規管 活動之持牌法團 ( 中央編號 AFN604), 亦是香港聯合交易所有限公司的交 易所參與者及香港期貨交易所註冊期貨代理商營業及通訊地址位於香港金 鐘夏慤道 16 號遠東金融中心 3702B ( 下稱 貴公司 ) 在本申請表所包含有眾數意義的名詞亦具單數名詞的意義, 反之亦然 確認及同意 1. 本人 / 吾等現確認貴公司已提供本人 / 吾等以下列條件和條款 ( 中或英文語言 ) 副本一份 ( 下稱 條款和條件 ): 證券帳戶條款和條件 ( 香港證券現金客戶, 香港證券保證金帳戶, 及環球證券保證金帳戶適用 )- 期貨帳戶條款和條件 ( 香港及環球期貨客戶適用 )- 本人承諾及決定自行於貴公司設立網站下載所選最新條件和條款詳閱, 網站為 本人 / 吾等同時謹此確認及同意會依照該條件和條款之約定進行交易活動 2. 風險披露聲明 : 本人 / 吾等謹此承認並確認本人 / 吾等已獲得按照本人 / 吾等所選擇的語言 ( 英文或中文 ) 的風險披露聲明, 當中包括, 但不限於載於條款和條件內之風險披露聲明, 及本人 / 吾等已獲邀請細閱此風險披露聲明, 提出問題及徵求獨立的意見 ( 如本人 / 吾等有此意願 ) 3. 客戶款項常設授權 : 本人 / 吾等謹此授權貴公司組合或合併本人 / 吾等於貴公司所維持的任何或全部獨立帳戶, 將該等獨立帳戶內任何數額之款項作出轉移, 以解除本人 / 吾等對貴公司的義務或法律責任, 不論此等義務和法律責任是確實或或然的 原有或附帶的 有抵押或無抵押的 共同或分別的 ; 及從本人 / 吾等在貴公司於任何時候維持的任何獨立帳戶之間來回調動任何數額之款項 4. 客戶證券常設授權 : 本人 / 吾等謹此授權貴公司依據證券借貸協議運用任何本人 / 吾等的證券或證券抵押品 ; 將任何本人 / 吾等的證券抵押品存放於認可財務機構, 作為該機構向貴公司提供財務通融之抵押品 ; 將任何本人 / 吾等的證券抵押品存於香港中央結算有限公司, 作為解除貴公司在交收上的義務和清償貴公司在交收上的法律責任的抵押品 本人 / 吾等明白中央結算因應貴公司的責任和義務而對本人 / 吾等的證券設定第一固定押記 ; 將任何本人 / 吾等的證券抵押品存於任何其他的認可結算所或任何其他獲發牌或獲註冊進行證券交易的中介人, 作為解除貴公司在交收上的義務和清償貴公司在交收上的法律責任的抵押品 ; 及如貴公司在進行證券交易及貴公司獲發牌或獲註冊進行的任何其他受規管活動的過程中向本人 / 吾等提供財務通融, 即可按照以上所述運用或存放任何本人 / 吾等的證券抵押品 5. 本人 / 吾等茲確認, 貴公司可不向本人 / 吾等發出通知而採取上述 3 及 4 之行動 6. 客戶款項常設授權 及 客戶證券常設授權 的有效期為十二個月, 自本授權簽署之日起計 ; 本人 / 吾等可以向貴公司發出書面通知撤回本授權, 該等通知之生效日期為貴公司真正收到該等通知後之 14 日起計 ; 本人 / 吾等明白若貴公司於本授權有效期滿前 14 日之前, 向本人 / 吾等發出書面通知, 提醒本人本授權即將屆滿, 而本人 / 吾等沒有在此授權屆滿前反對此授權續期, 則本授權應當作在不需要本人 / 吾等的書面同意下按持續的基準已被續期 SECTION F DISCLAIMERS 免責聲明 FP Sino-Rich Securities & Futures Limited (FPS) is a licensed corporation (CE No.: AFN 604), regulated by the Securities and Futures Commission under the Securities and Futures Ordinance (Cap. 571) to carry out Type 1 (dealing in securities), Type 2 (dealing in futures), Type 4 (Advising on Securities), Type 5 (Advising on Futures Contracts) and Type 9 (Asset Management) regulated activities. FPS is also an Exchange Participant of The Stock Exchange of Hong Kong Limited and a Futures Commission Merchant of Hong Kong Futures Exchange Limited, its business and office premises situates on 3702B, Far East Finance Centre, 16 Harcourt Road, Admiralty, Hong Kong. (herein after called the The Company ) In this Account Opening Form, the singular shall be deemed to include the plural and vice versa. CONFIRMATION AND CONSENT 1. I/We hereby confirm that the Company has provided me/us with a copy of the following terms and conditions (English or Chinese language) (hereinafter referred to as Terms and Conditions ): Securities Account Terms and Conditions (For Hong Kong Securities Cash, Hong Kong Securities Margin and Global Securities Margin Account Clients) Futures Account Terms and Conditions (For Futures Account (HK & Global) Clients ) I/We undertake and determine to take action to download the latest and updated terms and conditions from the Company s official website, for perusal. I/We hereby confirm and consent to carry out the trading activities in accordance with the Terms and Conditions. 2. RISK DISCLOSURE STATEMENTS : I/We hereby acknowledge and confirm that the Risk Disclosure Statements, including but not limited to the statements, set out in the Terms and Conditions, was provided to me/us in a language of my/our choice (English or Chinese), and I/we was/were invited to read the Risk Disclosure Statements carefully, ask questions and seek independent advice, at my/our liberty, where appropriate. 3. CLIENT MONEY STANDING AUTHORITY : I/We hereby authorize the Company to combine or consolidate any or all segregated accounts maintained by the Company, and the Company may transfer any sum of monies to and between such segregated account(s) to satisfy my/our obligations or liabilities to the Company, whether such obligations and liabilities are actual or contingent, primary or collateral, secured or unsecured, joint or several; and transfer any sum of monies interchangeably between any of the segregated accounts maintained at any time by the Company. 4. CLIENT STANDING AUTHORITY : I/We authorize the Company to apply any of my/our securities or securities collateral pursuant to a securities borrowing and lending agreement; deposit any of my/our securities collateral with an authorized financial institution as collateral for financial accommodation provided to the Company; deposit any of my/our securities collateral with Hong Kong Securities Clearing Company Limited (HKSCC) as collateral for the discharge and satisfaction of the Company s settlement obligation and liabilities. I/We understand that HKSCC will have a first fixed charge over my/our securities to the extent of the Company s obligations and liabilities; deposit any of my/our securities collateral with any other recognized clearing house, or another intermediary licensed or registered for dealing in securities, as collateral for the discharge and satisfaction of the Company s settlement obligations and liabilities; and apply or deposit any of my/our securities collateral in accordance with content above if the Company provide financial accommodation to me/us in the course of dealing in securities and also provide financial accommodation to me/us in the course of any other regulated activity for which the Company is licensed or registered. 5. I/We hereby acknowledge and confirm that the Company may take the action as mentioned in the above paragraphs 3 and 4 without giving me/us advance notice. 6. Client Money Standing Authority and Client Standing Authority both are valid for a period of 12 months from the date of this letter of authorization; these authorities may be revoked by giving the Company written notice, such notice shall take effect upon the expiry of 14 days from the date of the Company s actual receipt of such notice; I/We understand that these authorities shall be deemed to be renewed on a continuing basis without my/our written consent if the Company issues me/us a written reminder at least 14 days prior to the expiry date of these authorities, and I/We do not object to such deemed renewal before such expiry date.

8 SECTION G ACCOUNT OPENING DECLARATION & AUTHORIZATION 開戶聲明及授權 I/ We represent that the information on this All In One Investment Application Form is true, complete and correct and that the representations in this All-In-One Investment Application Form together with all Appendix are accurate. Your company is entitled to rely fully on such information and representations for all purposes, unless your company receives notice in writing of any changes. Your company is authorized at any time to contact any persons or entities, including but not limited to my/ our banks, brokers or any credit agencies for verifying the information provided herein (or any part of it). I/We hereby confirm that I/We have read and agreed to the contents of this All-In-One Investment Application Form, duly completed the Sections A-E, and have read and agree to all the Terms and Conditions, which shall form the entire agreement, enter between the Company and me/us in relation to the account(s). If there is any inconsistency between the Chinese and English versions, the English version shall apply and prevail. 本人 / 吾等聲明在此綜合投資開戶申請表所提供之一切資料均屬真實及完整無誤, 而此綜合投資開戶申請表及附件內所有陳述亦屬準確 除非貴公司收到更改有關本資料表內容之書面通知, 貴公司則有權在任何用途上完全依信此資料及聲明 貴公司有權隨時聯絡任何人士或實體, 包括並不限於本人 / 吾等之銀行 經紀或任何信貸機構以核實所提供之資料 ( 或其任何部分 ) 本人 / 吾等茲確認已經閱讀并同意此綜合投資開戶申請表之內容, 已填妥 A-E 部分, 且已經閱讀並同意全部條款和條件, 所有上述文件構成貴公司與本人 / 吾等就交易帳戶達成之協議 若中文版與英文版不一致, 應以英文版為準 口 I agree to receive news on FPS s promotion through and post. 本人同意透過電郵或郵件接收有關富泰中順中順推廣的資訊 Primary Account Holder Signature 主要帳戶人簽署 Joint Client Signature 聯名帳戶人簽署 Date (dd/mm/yy) 日期 ( 日 / 月 / 年 ) IF THIS DOCUMENT IS NOT EXECUTED BY THE CLIENT(S) IN FRONT OF FPS'S EMPLOYEE OR SUBMITTED WITH A CHEQUE DRAWN IN FAVOUR OF FP Sino-Rich Securities & Futures Limited for the sum of HKD10,000, BELOW SHOULD BE SIGNED BY A SPECIFIED PERSON* [if applicable] 若客戶 / 聯名客戶並非在富泰中順的僱員面前簽立此文件或連同港幣一萬元支票抬頭人註明 富泰中順證券期貨有限公司 一併遞交, 則以下應由指定人士 * 簽署 [ 若適用者 ] The undersigned person hereby personally observe the above Client / Joint Clients signing this document (together with the Terms and Conditions) and certify the related identification document(s) of such Client(s). 下述簽署人士謹此見證上述客戶 / 聯名客戶簽立此文件 ( 連同該條款和條件 ) 及驗證其有關的身份證明文件 Signature of Witness 見證人簽署 Name of Witness 見證人姓名 Profession / Title 所屬專業 & Membership no. 會員編號 & Company stamp 公司印章 Date (dd/mm/yy) 日期 ( 日 / 月 / 年 ) ID/Passport No. of witness: 見證人身份證或護照號碼 : Witness Address 見證人地址 : *Any SFC licensed or registered person, an affiliate of such person, a Justice of the Peace, a Branch Manager of a bank, Certified Public Accountant, Lawyer or Notary Public 任何香港證監會持牌人或註冊人 其聯繫人士 太平紳士 銀行分行經理 執業會計師 律師或公證人 FOR OFFICE USE ONLY 以下由富泰中順填寫 I/We, FPS representative(s), hereby declare and confirm that I/we have provided the Risk Disclosure Statements annexed hereto in a language of the Client's choice (English or Chinese) and invited the Client / Joint Client to read the Risk Disclosure Statements, ask questions and seek independent advice, at the Client/ Joint Client liberty, where appropriate. 本人 / 吾等為富泰中順的註冊職員, 並謹此聲明及確認本人 / 吾等已按照上述客戶 / 聯名客戶所選擇的語言 ( 中文或英文 ) 提供附於本表的風險披露聲明及邀請客戶閱讀該風險披露聲明 提出問題及徵求獨立的意見 ( 如客戶 / 聯名客戶有此意願 ) The above Client / Joint Client signature(s) was / were made in my / our presence. 以上客戶 / 聯名客戶簽署乃於本人 / 吾等面前簽立 Signature of FPS Staff Staff Name and CE No. of FPS Staff Date (dd/mm/yy) 富泰中順職員簽署 富泰中順職員名稱及中央編號 日期 ( 日 / 月 / 年 ) FOR OFFICIAL USE ONLY 僅供內部使用 AE Code: Handled by Checked by RO/Mgt Input Data by Data Checked by Specimen Scanned Initial Date