Please use this form if you want the Hong Kong Offer Shares to be issued in your name
如 閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格

pl
e樣

版

This Application Form uses the same terms as defined in the prospectus of NIRAKU GC HOLDINGS, INC.*（株式社）(the “Company”) dated Tuesday, 24 March 2015 (the “Prospectus”).
Staple your
本申請表格使用NIRAKU GC HOLDINGS, INC.*（株式 社）
payment（「本公司」）日期為二零一五年三月二十四日（星期二）的招股章程（「招股章程」）所界定的詞語。
Neither this Application Form nor the Prospectus constitutes an offer to sell or the solicitation of an offer to buy any
here
Hong Kong Offer Shares in any jurisdiction other than Hong Kong. The Hong Kong Offer Shares may not be offered請將股款or sold in the United States without registration or an exemption from registration under the U.S.
Securities Act.
.S. S
本申請表格及招股章程概不構成在香港以外司法權區要約出售或游說要約購買香港發售股份。若無
買香港發售
香港發
緊釘在此
根據美國《證券法》登記或豁免登記，香港發售股份不得在美國提呈發售或出售。
出售。
售。
This Application Form and the Prospectus may not be forwarded or distributed or reproduced (in whole or in part)whatsoevert) in any manne
manner whin any jurisdiction where such forwarding, distribution or reproduction is not permitted under the law of that
hat jurisdiction.
任何根據當地法例不得發送、派發或複製本申請表格及招股章程的司法權區內概不得發送或派發或複製（不論方式，也發送或派發或複製
送或派發或複製（不論方式，
論方
不論全部或部分）本申請表格及招股章程。
Copies of the Prospectus, all related Application Forms and the other documents specified in “Appendix
ppendix
endix VII — Documents Delivered to theRegistrar of Companies and Available for Inspection” to the Prospectus have been registered by the Registrar of Companies in Hong Kong.
Hong Kong Exchanges and Clearing Limited, The Stock Exchange of Hong Kong Limitedd (the “Stockk Exchange”), Hong Kong Se
Securities
Clearing Company Limited (“HKSCC”), the Securities and Futures Commission of Hongg Kong (the “SFC”) and the Registrar of Companies
CompaniComof Hong Kong take no responsibility for the contents of these documents.
招股章程、所有相關申請表格及招股章程「附錄七－送呈公司註冊處處長及備查文件」
長及備查文件」所述其他文件已送呈香港公司註冊
所述其他文件已送呈香港公處處長登記。香港交易及結算所有限公司、香港聯合交易所有限公司
公司
司（「聯交所」）、香港中央結算有限公司（「香港結算」）、香港證券及期貨事務監察委員會（「證監會」）及香港公司註冊處處長對此等文件的內容概不負責。
冊處處長對此等文件的內容概不負責冊處處長對此等文件的內容概不負責。

株式 社
NIRAKU GCC HOLDINGS,HOLDINGSDINGGS,S, INC.*(Incorporated
ated
ed in Japan with limited liability)
liability)
liabilit（於日本註冊成立的有限公司）
於日本註冊成立的有限公司）
日本註冊成立的有限Sam

Stock Codede : 1245
股份代號 ： 1245
Maximum
per Offer Share (payable in full on
imum Offerer Price : HK$1.28
HK$applicationin Hong Kong dollars, subject to refund,appplus brokerageof 1%, SFC transaction levy ofbro
0.0027%0.0027 and Stock Exchange trading fee of 0.005%)
最高發售價 ： 每 股 發 售 股 份 1.28港 元（須 於 申 請 時 以 港 元 繳足，可予退還，另加1%經紀佣金、0.0027%證
足監會交易徵費及0.005%聯交所交易費）
You should read
conjunction with the Prospectus, which contains further informationad this Application
lication Form in conjunctio
coon the application
cation procedures.
ocedures.
招股章程尚有其他關於申請程序的其他資料，本申請表格應與招股章程一併閱讀。
程尚有其他關於申請程序的其他資料
他關於申請程序的

Application Form 申請表格
ApplicTo:
o: NIRAKU GC HOLDINGHOLDINGS, INC.*( 株式 社
Shenyin Wanguo Capital (H.K
(H.K.) Limited
Thee Hong Kong
Underwriterng Underwrit
U)✄

Applicants’ declaration
declarath terms anda conditions and application
I/We agree to theprocedures in thiss Application
App
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
benefit of any person. Please refer to the last four bullets
of “Effect of completing and submitting this ApplicationForm” section.
* For identification purpose only
僅供識別

致：NIRAKU GC HOLDINGS, INC.*(株式 社)
申銀萬國融資（香港）有限公司
香港包銷商
申請人聲明
本人╱吾等同意本申請表格及招股章程的條款及
條件以及申請程序。見本申請表格「填交本申請
表格的效用」一節。
警告：任何人士只限作出一次為其利益而進行的認購申請。請參閱「填交本申請表格的效用」一節
最後四點。

Please use this form if you want the Hong Kong Offer Shares to be issued in your name
如 閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格
Signed by (all) applicant(s) (all joint applicants must sign):
由（所有）申請人簽署（所有聯名申請人必須簽署）：For Broker use 此欄供經紀填寫 Lodged by 遞交申請的經紀
Broker No. 經紀號碼
Broker’s Chop 經紀印章............................................................................................................................
Date 日期：..............................
D日..............................
M月..............................
Y年

Cheque/banker’s cashier order number
er 支票╱銀行本票號碼
支票╱銀行本支票╱銀行本票

Name of bank on which cheque/Banker’sheque/Banker
que/Banker’’s cashier order is drawn(see “How to make yourur application”
application section) 兌現支票╱銀行
本票的銀行名稱（見「申請手續」一節）
見「申請手續」一節）
申請手續」一

Sa
m
pl
e樣
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Number of Hong Kong Offer Shares applied for (not more than 15,000,000 shares)
申請香港發售股份數目（不超過15,000,000股股份）

Total amount 總額HK$

港元Name in English 英文姓名 名稱

Family name or company name 姓氏或公司名稱

Forename(s)me(s)) 名字

Name in Chinese 中文姓名 名稱

Family name or company name 姓氏或公司名稱

Forename(s)orename(s)ame(s) 名字

Occupation in English 職業（以英文填寫）KongNo./Passport No./Hong Kong businessHong Kong Identity
dentity Card No
No./PasNo.*
registration
ggistration No.** (Please deletdelete aas appropriate) 香港身分證號碼╱護照號碼╱香港商業登記號碼 *（請刪除不適用者）
護照號碼╱香港
港商業登 記記號

Names of all other joint applicants in English (if any)
ny)
所有其他聯名申請人的英文姓名╱名稱（如有）
如有）
1)
2)
3)

Hong Kong Ide
Identity Car
Card No./Passport No./Hong Kong businessall other joint applicants* (Please delete as
registration No. of alregis
所有其他聯名申請人的香港身分證號碼╱護照號碼
appropria
appropriate)
pp
p p
所有其
╱香港商業登記號碼*（請刪除不適用者）╱香港商業登記
香港
1)
2)
3)

Hong Kong address in English and telephone no. (joint applicants should
give the address and the telephone number of the first-namedshoapplicant only) 香港地址（以英文填寫）及電話號碼（聯名申請人只須填寫排名首位申請人的地址及電話號碼）地址（以英文填寫）及電話號碼（聯名申請人
文填寫）及電話號碼（聯名申請人

Telephone No. 電話號碼For Nominees:ominees: You will be treated as app
applying for yo
your own benefit
if youu do not complete this section. Ple
Please provide aan account number
orr identification
beneficial owner. 由代名人
entification code for each (joint(joint) beneficia
遞交：代名人若不填寫本節，是項認購申請將視作為閣下利
交：代名人若不填寫本節，是項認購申：代名人若不填寫本節，是益提出。請填寫每名
實益擁有人的賬戶號碼或識別編
出。請填寫每名
請填寫（聯名）
聯名 實益擁有碼。

ADDRESS LABEL 地址標貼
地址標貼 (Your name(s) and address in Hong
Kong in BLOCK letters 請用英文正楷填寫姓名╱名稱及香港地請址)For Internal use
此欄供內部使用

Please use this form if you want the Hong Kong Offer Shares to be issued in your name
如 閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格* (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’s
validity.
個別人士須填寫其香港身分證號碼或（如非香港身分證持有人）護照號碼。法人團體須填寫其香法人團體須
人團
港商業登記號碼。每名聯名申請人均須提供其相關號碼。該等香港身分證號碼╱護照號碼╱香證號碼╱護照號碼號碼╱護照港商業登記號碼將轉交第三方以核實申請表格的有效性。

e樣版(2) Part of the Hong Kong Identity Card number/passport number of you or, foror joint applicants, the first-named
applicant may be printed on your refund cheque (if any). Your banker may requiree verification of your Hong Kong
Identity Card number/passport number before you can cash your refund
ndd cheque.
chequ
日後如需退回申請股款，退款支票上或會印有 閣下或（如屬聯名申請人）
屬聯名申請人）排名首位申請人的香排名首位申請人
排名首位申請人的
港身分證號碼╱護照號碼的一部分。銀行兌現退款支票前或會要求查證
支票前或會要求查證
票前或會要求查證 閣下的香港身分證號
閣下的香港身碼╱護照號碼。

Sampl(3) If an application is made by an unlisted company and:•the principal business of that company is dealing in securities;
seecurities;
urities; and•you exercise statutory control over that company,y,then the application will be treated as being made for your benefit.
benefitt
倘若申請人是一家非上市公司，而：• 該公司主要從事證券買賣業務；及；及及• 閣下對該公司可行使法定控制權，制權，
是項申請將視作為 閣下的利益提出。
利益提出。

Please use this form if you want the Hong Kong Offer Shares to be issued in your name
如 閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格

IMPORTANT

版

Potential investors should note that under Japan law, the Shares are “bearer shares” in nature. Ownership of the Sharescan be transferred simply by the delivery of share certificates, with or without the transferor and the transferee having
signed any document evidencing such transfer. This creates inherent risks for Shareholders and potential
ntia investors whochoose to hold the Shares by physical possession of share certificates. To avoid these risks, which
h are veryv significant
in the opinion of the Directors, potential investors are strongly recommended to hold their
eir investments
investm
investmen in the
Company through CCASS by: (i) completing the YELLOW Application Forms; or (ii) giving
ving electronic application
applica
ap
instructions to HKSCC. Please refer to the section “Key Japan Legal and Regulatory
Shares”” iny Matters - A. Bearer Sh
Sharesthe Prospectus for details. Potential investors who choose to apply for the Hong Kongong
ng Offer Shares in their own nameunder this Application Form do so at their own risk.

e樣

Further, due to certain Japan legal and regulatory provisions, CCASS Beneficial
eneficial Owners are subject to certaincertcdisadvantages as set out in detail in the section “Key Japan Legal
all and Regulatory Matters - A. Bearer Shares
Sh
S
Recommended Measures for our Shareholders and Potential Investors”
rs”” in the Prospectus. For example, CCASSCCAS Beneficial
Owners are subject to a higher withholding tax rate, and theyy may not inspect the Company’s
unlessCompany
Compa ’s Share RegisterR
allowed to do so under the Personal Information Protection Act. Despite
espite these disadvantages, given theth risks associatedwith the “bearer” Shares (which are very significant in thehee opinion of the Directors), it is the Board’s strong
recommendation that potential investors should hold their investments
investmeents in the Company throughthrougthrou CCASS.

重要事項
項

m

pl

潛在投資者應注意，根據日本法律，股份屬於股份屬於
於「不記名股份」。股份擁有權可簡單透過交付股票而轉
。股。股份擁讓，不論出讓人與承讓人有否簽立任何文件證明有關轉讓。這對選擇透過擁有實物股票而持有股份
立任何文件證明有關轉讓。這對選擇文件證明有關轉
的股東及潛在投資者造成固有風險。為避免該等風險
，強烈建議潛在
有風險。為避免該等風險
為避免該等風險（董事認為該等風險非常重大）（董（董事認為該投資者透過中央結算系統：(i)填妥黃色申請表格；或(ii)向香港結算發出電子認購指示而持有於本公(i)填妥黃色申請表格；或色申請表格； (ii)向香港
司的投資。有關詳情請參閱招股章程一節。潛在投資者
參閱招股章程股章程「主要日本法律及監管事宜－A.不記名股份」「主要日本法「主要日本法律及監管選擇根據本申請表格以本身名義申請香港發售股份，須自行承擔有關風險。
格以本身名義申請香港發售股份，須名義申請香港發售股份Sa

此外，由於若干日本法律及監管規定，中央結算系統實益擁有人受到招股章程「主要日本法律及監管若干日本法律及監管規定，
律及監管規定，中央結算事宜－A.不記名股份－向股東及潛在投資者推薦的措施」
一節中詳述的若干不利條件所規限。例如，
不記名股份－向股東及潛在投資者推份－向股東及潛在
中央結算系統實益擁有人須繳納較高的預扣稅率，且除非《個人資料保護法》准許，否則彼等不得查
結算系統實益擁有人須繳納較高的預
算系統實益擁有人須繳納較閱本公司的股東名冊。儘管出現該等不利條件，鑒於存在涉及
「不記名」股份的風險（董事認為該等風本公司的股東名冊。儘管出
本公司的股東名冊。儘管出現該等不險非常重大）
非常重大），董事會強烈建議潛在
，董事會強烈，董事會強烈建議潛在投資者透過中央結算系統持有於本公司的投資。

Please use this form if you want the Hong Kong Offer Shares to be issued in your nameHow to make your application
1.

Use the table below to calculate how much you must pay. Your application must be for a minimum of 2,000 Hong
Kong Offer Shares and in one of the numbers set out in the table, or your application will be rejected.
NUMBER OF SHARES THAT MAY BE APPLIED FOR AND PAYMENTS
Amount payable
on application
HK$

No. of Hong Kong
Offer Shares
applied forAmount payable
on application
HK$

No. of Hong Kong
Offer Shares
applied forAmount payable
on application
HK$

No. of Hong Kong
Kon
ffer Shares
Offerapplied for

2,000
4,000
6,000
8,000
10,00012,00014,00016,00018,00020,00030,0002,585.80
5,171.60
7,757.39
10,343.19
12,928.99
15,514.78
18,100.58
20,686.37
23,272.17
25,857.97
38,786.96

40,00050,00060,00070,00080,00090,000100,000
200,000
300,000
400,000
500,000

51,715.94
64,644.93
77,573.91
90,502.90
103,431.88
116,360.87
129,289.86
258,579.71
387,869.57
517,159.42
646,449.28

600,000
700,000
800,000
900,000
1,000,000
2,000,000
3,000,000
000
4,000,000
000,000
00,0005,000,000
0,000
6,000,000,000,000000
7,000,000
7,0000,000,000

775,739.14
8,000,000
00,000905,028.99
8.9
8.99
9,000,000
1,034,318.85
4,318.85.85 10,000,000
0,000,000
1,163,608.70,163,608.70,
11,000,000
1,292,898.56
1,292,898
12,000,000
2,000,000
2,585,797.12 13,000,000
00,0003,878,695.68
3,878,695.
14,000,000(1)
1)
5,171,594.24 15,000,000
56,464,492.80
7,757,391.36
9,050,289.92

AmountAm
payableo application
ap
on
HK
HK$

10,343,188.48
10,343
11,636,087.04
11,636,0
12,928,985.60
14,221,884.16
14,221,8
15,514,782.72
15,514,7
15,514,782.7
16,807,681.28
16,807,
16,807,6
18,100,579.84
18,10
18,
19,393,478.40
19

e樣
版

No. of Hong Kong
Offer Shares
applied for

Maximum number of Hong Kong Offer Shares you mayy apply for.

2.

Complete the form in English and sign it.
t. Only
nly written signatures will
wil bee acceptedac(and not by way of personalchop).

Sa
m
pl

(1)

3.

Staple your cheque or banker’s cashier orderer to the form. Each aapplication for the Hong Kong Offer Shares must be
accompanied by either one separate
eparate chequeque or one separate banker’sbankerb’s ccashier order. Your application will be rejected
if your cheque or banker’ss cashier order does not meet all the following
requirements:
foll

The cheque must:

B
Banker’s cashier order must:

•
•
•
•

be in Hongng Kong dollars;ars;
not bee post-dated;ed;be made payable to “Horsford“Horsford Nominees
No
LimitedL- NIRAKU Public Offer”;
be crossed “Account
ccount Payee Only”;
O
Only”;•

be drawn on your Hong Kong dodollar bank accountin Hong Kong; andshow
w your accountaccoun name, which must either be
pre-printed
cheque, or be endorsed on theted
ed on the cheq
back by a personby the bank. Thiserson authorised
auaccount name must correspond with your name.
If it is a joint application, the account name must
be the same as the first-named applicant’s name.

•• be issued by a licensed bank in Hong Kong, and haveyour name certified on the back by a person authorisedby the bank. The name on the banker’s cashier ordermust correspond with your name. If it is a joint
application, the name on the back of the banker’s
cashier order must be the same as thefirst-named applicant’s name.

Please use this form if you want the Hong Kong Offer Shares to be issued in your name
Tear off the Application Form, fold it once and lodge your completed Application Form (with cheque or banker’s
cashier order attached) to one of the collection boxes at any of the following branches of Standard Chartered Bank
(Hong Kong) Limited:
BranchAddress

Hong Kong Island Des Voeux Road BranchNorth Point Centre Branch

KowloonKwun Tong Hoi Yuen Road
Mongkok Branch

Tai Po Branch

Shatin Plaza Branch

5.

G/F, Fook Cheong
heongg Building,
No. 63 Hoi
oii Yuen Road, Kwun Tong, Kowloon
Kowl
Shop B, G/F, 1/F & 2/F,
2617-6237-623
623 Nathan Road, Mongkok
MongkoG/F shop No. 2, 23 - 25 Kwong Fuk
F Road,Tai
ai Po Market, Tai Po
Shop No. 8, Shatin Plaza,
21-27
211-27 Shatin Centre Street,
StreetStree Shatin,
New T
Territories,
erritories, Hong
Ho Konge樣

New Territories

Standard Chartered Bank Building,lding,
ng,
4-4A, Des Voeux Road Central,entral,ral, Central
Shop G, G/F, North Point
Centre,int
nt Ce
284 King’s Road, Northorth Point

版

4.

Your Application Form can be lodged at theseesee times:timm

The latest time for lodging
Friday, 27 March 2015. The application lists will be
dging your application is 12:00 noonn
on F
open between 11:45
only to the weather conditions, as described in the
45 a.m. andnd 12:00 noon on that day, subject
subj
su
section “How too Apply for— 10.
or Hong Kong Offer SharesSh
1 Effect of Bad Weather on the Opening of the Application
Lists” in thee Prospectus.
s.

Sa

6.

pl

Tuesday, 24 March 20155 — 9:00
00 a.m. to 5:00 p.m.
pWednesday, 25 Marchh 2015 — 9:0
9:00 a.m. to 5:00 p.m.
Thursday,day, 26 March
arch 2015 — 9:00 a.m. to 5:00
5 p.m.
Friday, 27 March 2015 — 99:00 a.m. tot 12:00 noon

如

閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格

申請手續
1.

使用下表計算 閣下應付的款項。 閣下申請認購的股數須至少為2,000股香港發售股份，並為
下表所列的其中一個數目，否則恕不受理。
可供申請認購股份數目及應繳款項
申請時
應繳款項
港元

申請認購的
香港發售
股份數目

申請時
應繳款項
港元

申請認購的
香港發售
股份數目

2,000
4,000
6,000
8,000
10,00012,00014,00016,00018,00020,00030,0002,585.80
5,171.60
7,757.39
10,343.19
12,928.99
15,514.78
18,100.58
20,686.37
23,272.17
25,857.97
38,786.96

40,00050,00060,00070,00080,00090,000100,000
200,000
300,000
400,000
500,000

51,715.94
64,644.93
77,573.91
90,502.90
103,431.88
116,360.87
129,289.86
258,579.71
387,869.57
517,159.42
646,449.28
9.28

600,000
700,000
800,000
900,000
00
1,000,000
2,000,000
0,000
3,000,000
00,0004,000,000
00
5,000,000
5,0000,000
0,000
6,000,000
6,000,0000
7,000,000
000,000

申請時
應繳款項
港元

申請認購的
認購的
香港發售
股份數目

39.14
9.14
775,739.14
8,000,000
5,028.9999905,028.99
9,000,000,034,311,034,318.85
10,000,000
1,163,608.70,163,608.70 11,000,000,000,000
1,292,898.56 12,000,000
0,000
2,585,797.12 13,000,000
3,878,695.68 14,000,000
5,171,594.24 15,000,00
15,000,000(1(1)
6,464,492.80
7,757,391.36
9,050,289.92

申請時
申
應繳款項
應繳款
應
港元
港

10,343,1
10,343,188.48
11,636,087.04
12,928,985.60
12,928,9
14,221,884.16
14,221,884
14,221,8
15,514,782.72
15,51415,516,807,681.28
16,
18,100,579.84
19,393,478.40

Sa
m
pl
e樣
版

申請認購的
香港發售
股份數目

(1)

閣下可申請認購的香港發售股份最高數目。
。

2.

以英文填妥及簽署申請表格。只接納親筆簽名
。只接納親筆簽名
納親筆簽名（不得以個人印章代替）（不得以（不得以個人印章。

3.

閣下須將支票或銀行本票釘於表格上。每份香港發售股份申請須附一張獨立開出支票或一張獨
本票釘於表格上。每份香港發售股份格上。每份香立開出銀行本票。支票或銀行本票必須符合以下所有規定，否則有關的認購申請不獲接納：
支票或銀行本票必須符合以下所有
銀行本票必須符合以

支票必須：銀行本票必須：• 為港元；
元；• 不得為期票；
得為期票；• 註明抬頭人為「浩豐代理人有限公司－NIRAKU公開發售」；「浩豐代理人有限公浩豐代理人；• 劃線註明「只准入抬頭人賬戶」「只准入抬頭• 從 閣下在香港的港元銀行賬戶中開出；及閣下在香港
閣下在香港的港元• 顯示 閣下的賬戶名稱，而該賬戶名稱必須
閣下的
閣下的賬戶名已預印在支票上，或由有關銀行授權的人
支票上
士在支票背書。賬戶名稱必須與 閣下姓
名╱名稱相同。如屬聯名申請，賬戶名稱必須與排名首位申請人的姓名╱名稱相同。

• 須由香港持牌銀行開出，並由有關銀行授
權的人士在銀行本票背面簽署核證 閣下
姓名╱名稱。銀行本票所示姓名╱名稱須
與 閣下姓名╱名稱相同。如屬聯名申請，銀行本票背面所示姓名╱名稱必須與排名首
位申請人的姓名╱名稱相同。

如

分行

地址

香港島

德輔道分行
北角中心分行

中環德輔道中4-4A號渣打銀行大廈
銀行大廈
行大北角英皇道284號北角中心地下G舖
中心地下
心地 G舖
舖

九龍

觀塘開源道分行
旺角分行

觀塘開源道63號福昌大廈地下
福昌大廈地下旺角彌敦道617-623號地下B鋪，一樓及二樓
17-623-62 號地下號地下BB鋪，一樓及二樓

新界大埔分行
沙田廣場分行大埔廣福道23-25號地下1-2號舖
福道23-25
福道 23- 號地下
地下1-2
-2號舖
號舖
沙田正街21-27號沙田廣場地下8號舖
田正街
正街21-27
21-27號沙田廣場地下
號沙田廣場地下88號舖

閣下可於下列時間遞交申請表格：版

5.

請撕下申請表格，對摺一次，然後將填妥的申請表格（連同支票或銀行本票）投入渣打銀行（香港）有限公司下列任何一家分行特設的收集箱：e樣

4.

閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格

二零一五年三月二十四日（星期二） － 上午九時正至下午五時正上 午九時正至下午五時正二零一五年三月二十五日（星期三） － 上午九時正至下午五時正上午九九時正至下午五時正時正至下午五時正二零一五年三月二十六日（星期四）四） － 上午九時正至下午五時正上午九時
時正至下午五時
正至下午五
二零一五年三月二十七日（星期五）期五） － 上午九時正至中午十二時正
上午九時正 至中午
午mpl

截止遞交申請的時間為二零一五年三月二十七日
五年三月二十七日
十七日（星期五）星期五）中午十二時正。本公司將於當日上午
中午十十一時四十五分至中午十二時正期間登記認購申請，唯一會影響此時間的變化因素為當日的天
二時正期間登記認購申請，唯一會影
間登記認購申請，
氣情況（詳見招股章程「如何申請香港發售股份－一節）。
如何申請香港發售股份－
香港發售股份 10.惡劣天氣對辦理申請登記的影響」
110.惡劣天Sa6.

Please use this form if you want the Hong Kong Offer Shares to be issued in your name

株式 社
NIRAKU GC HOLDINGS, INC.*(Incorporated in Japan with limited liability)

GLOBAL OFFERING

2.
3.
4.

5.

•
•

•

•

m

pl

6.

Who can apply
You and any person(s) for whose benefit you are applying must be
18 years of age or older and must have a Hong Kong address.
If you are a firm, the application must be in the individual members’
names.
The number of joint applicants may not exceed 4.
If you are a body corporate, the application must be signed by aduly authorised officer, who must state his representative capacity,and stamped with your corporation’s chop.
You must be outside the United States, not be a United States Person(as defined in Regulation S) and not be a legal or natural person of
the PRC.
Unless permitted by the Listing Rules, you cannot apply for anyy
Hong Kong Offer Shares if you are:any and/•an existing beneficial owner of Shares in the Company
or any of its subsidiaries;
pany and/•a Director or Chief Executive Officer of the Company
or any of its subsidiaries;
ting Rules) of any off•
a close associate (as defined in the Listing
the above;
ned in the Listing
isting Rules) of•a core connected person (as defined
ted person of thethe Company or will become a core connected
on of the Global
Company immediately upon completion
Offering; orOffe•have been allocated or have applied for any International Offer
wise participate
ate in the International Offering.
Shares or otherwise

e樣

A.
1.

ceivedeived and read the Prospectus and have
hav
confirm that you have received
rmationmation and representations contained
contain in the
only relied on the information
king your application and will not rely on any
Prospectus in making
on or representations
entations except those in any supplement
supother information
ectu
ectus;
to the Prospectus;
Off
confirm that you are aware of the restrictions on the Global Offering
Prospectu
in thee Prospectus;
gree that none of the Company, the Sole Global Coordinator,
Coo
Coor
agree
the
respect directors,
dire
Sole Sponsor, the Underwriters, their respective
officers,
oth parties involved
employees, partners, agents, advisers and any otherliabl for any information andinn the Global Offering is or will be liable
epresentations not in the Prospectus
Prospe(an any supplement to it);representations(andundertake and confirm that you or the person(s) for whose benefit
you havee made the application have
hav not applied for or taken up, oryouindicaated an interest for, andan will
wil not apply for or take up, or indicate
indicatedinterest for, any Offer Shares
interSh
an interest
under the International Offering
participaated in theparticiphe InternationalInI
nor participatedOffering;
disclose to thedisc
th Company, our Hong Kong Share Registrar,
agree to disclose
the receiving bank, the Sole Global Coordinator, the Sole Sponsor,
Under
an
the Underwriters
and/ortheir respective advisers and agents any
whi they may require about you and the person(s)personal data which
ben you have made the application;
for whose benefit
law of any place outside Hong Kong apply to yourif the laws
applicatapplication,agree and warrant that you have complied with all
such laws and none of the Company, the Sole Global Coordinator,
th Sole Sponsor and the Underwriters nor any of their respective
theofficers or advisers will breach any law outside Hong Kong as aresult of the acceptance of your offer to purchase, or any action
arising from your rights and obligations under the terms andconditions contained in the Prospectus and this Application Form;agree that once your application has been accepted, you may not
rescind it because of an innocent misrepresentation;agree that your application will be governed by the laws of Hong
Kong;
represent, warrant and undertake that (i) you understand that theHong Kong Offer Shares have not been and will not be registeredunder the U.S. Securities Act; and (ii) you and any person for whose
benefit you are applying for the Hong Kong Offer Shares are outside
the United States (as defined in Regulation S) or are a person
described in paragraph (h) (3) of Rule 902 of Regulation S;
warrant that the information you have provided is true and accurate;agree to accept the Hong Kong Offer Shares applied for, or any
lesser number allocated to you under the application;authorise the Company to place your name(s) on the Company’s
register of members as the holder(s) of any Hong Kong Offer Shares
allocated to you, and the Company and/or its agents to send any
share certificate(s) and/or any refund cheque(s) to you or the
first-named applicant for joint application by registered post at
your own risk to the address stated on the application, unless you
have chosen to collect the share certificate(s) and/or refund
cheque(s) in person;版•

Conditions of your application

Sa

minee
B. If you are a nominee
re than one application for the Hong
Hon
You, as a nominee, may make more
res by: (i) giving electronic instructions to HKSCC via
Kong Offer Sharesing and Settlement
ement System
Sys(“CCASS
CCAS ”)) (if( you are a CCASS
Central Clearing(“CCASS”)t);; or (ii) using a WHITEHITE oro YELLOWLLO Application
Applica
Participant);
Form,
dge
ge more than one application in your own namenam on behalf ofand lodge
erent
ent beneficial owners.
different
subm
C..
Effect of completing and submitting
this Application Form
ompleting and submitting
submittin this Application
Applicati Form, you (and if you
By completing
y jointly and severally) for yourself or as
are joint applicants, each off youominee on behalfbean agent or a nomineeof each person for whom you act:
execu all relevant
rele•
undertakee to execute
documents and instruct andCanauthorise thee Company
and/orthe Sole Global Coordinator (ornominee as agents of the Company, to execute
their agents or nominees),
any documents for you and to do on your behalf all things necessary
to register any Hong Kong Offer Shares allocated to you in yourname as required by the Articles;•
agree to comply with the Companies Ordinance, the Companies(Winding Up and Miscellaneous Provisions) Ordinance and the
Articles;•confirm that you have read the terms and conditions and application
procedures set out in the Prospectus and in this Application Formand agree to be bound by them;

•

•
•
•

•
•
•

Please use this form if you want the Hong Kong Offer Shares to be issued in your name••

If you are an individual who is eligible for personal collection, you must
not authorise any other person to collect for you. If you are a corporate
applicant which is eligible for personal collection, your authorised
representative must bear a letter of authorisation from your corporation
stamped with your corporation’s chop. Both individuals and authorised
representatives must produce, at the time of collection, evidence of identity
acceptable to the Hong Kong Share Registrar.
d/or Share
Shar certificate(s)If you do not collect your refund cheque(s)) and/or
fied for collection,collection theyth will bepersonally within the time period specified
ecified on this Application
Applicatio
Applidispatched promptly to the address specifiedFormk.
by registered post at your own risk.
0,000
00 Hong Kong Offer Shares, youryo refundIf you apply for less than 1,000,000
rtificate(s)ificate(s) will be sent to the address on thecheque(s) and/or share certificate(s)relevant Application Form onn or before Thursday, 2 April 2015, byregistered post and at your own risk.
mone
Refund of your moneyot receive any Hong Kong Offer Shares or if your
you application
If you doo not
cepted in part only or if the conditions of theth Hong
Hon Kong Public
is accepted
ering are not fulfilled in accordance with the sectionsec
sectio “Structure of theOffering
Offerin — Conditions of the Global Offering”
OfferO
Global Offeringin the Prospectus
our application is revoked, the Company
C
Compan will refund to you youror if yourapplication monies (including the related
relate 1% brokerage, 0.0027% SFC
application
Stoc ExchangeExchtransactionn levyy and 0.005% Stock
trading fee) without interest.
he final Offer
Offfer Price is less than the maximum Offer Price, the Company
If theill refund to you
you the surplus application
ap
will
monies (including the related% brokerage, 0.0027%
0.0
0 027% SFC
S
1%transaction levy and 0.005% Stockxchange trading fee) withoutw
Exchange
interest.
proce
The refund procedures
are stated in the section “How to Apply for Hong
Kong Offer Shares — 14
14. Despatch/Collection of Share Certificates andMoniesRefund M
Monies”” in tthe Prospectus.

e樣•

declare and represent that this is the only application made and theonly application intended by me/us to be made to benefit me/us or
the person for whose benefit I am/we are applying;understand that the Company and the Sole Global Coordinator will
rely on your declarations and representations in deciding whether
or not to make any allotment of any of the Hong Kong Offer Shares
to you and that you may be prosecuted for making a false
declaration;(if the application is made for your own benefit) warrant that noother application has been or will be made for your benefit on a
WHITE or YELLOW Application Form or by giving electronic
application instructions to HKSCC or through the White FormeIPO service by you or by any one as your agent or by any otherperson; and(if you are making the application as an agent for the benefit ofanother person) warrant that (i) no other application has been or
will be made by you as agent for or for the benefit of that person orby that person or by any other person as agent for that person on a
WHITE or YELLOW Application Form or by giving electronic
application instructions to HKSCC and (ii) you have due authority
to sign the Application Form or give electronic application
instructions on behalf of that other person as their agent.

版

•

D.
Power of attorney
If your application is made through an authorised attorney, the Company
and the Sole Global Coordinator may accept or reject your application atence
their discretion, and on any conditions they think fit, including evidenceof the attorney’s authority.

Sa

m

pl

g Kongong Offer
Determination of Offer Price and Allocation of HongSharesnd Friday, 27 Marchh
The Offer Price is expected to be fixed on or aroundm Offer Price of HK$1.2
2015. Applicants are required to pay the maximum
HK$1.28
th 1% brokerage,
ge, 0.0027%
for each Hong Kong Offer Share together withading fee. If the
SFC transaction levy and 0.005% Stockk Exchange trading
Offer Price is not agreed between thee Company andd the Sole Global
alf of the Underwriters)
derwriters) on or before
Coordinator (for itself and on behalf
Wednesday, 1 April 2015, the Global Offering will not proceed and will
lapse.
ong Offer Sharesres will not be processed and no
Applications for Hong Kong
ong Kong Offer
ffer Shares will be made until theallotment of any Hongose.
application lists close.
nnounce the fixed Offer Price,
Pri the indication
indi
The Company expects to announce
he International Offering, theth level of ap
of the level of interest in theapplicationsbof allounder thee Hong Kong Public Offering and the basis
allocation of theg Kong Public Offering on Thursday,Thursday 2 April 20
Hong2015 in the Southhinaa Morning Post (in English), the HEc
China
Hong Kong Economic
Journal (inChinese),hinese),ese), the Stock Exchange
ExchanExchange’s’s webs
website at www.hkexnews.hk
wwwand theCompany’s
pany’’s website at www.ngch.co.jp.
pany
wwwwww.ngch.co.jp. Re
Results of allocations in the
Hong Kong
ong Public Offering,g, anda the Hong Kong Identity Card/passport/siness registration
registrat numbers
numbe of successful applicants (where
Hong Kong businessavaila on the above websites.
applicable) will be available
If your application forr Hong Kong Offer Shares is successful (in whole
or in part)If you apply for 1,000,000 or more Hong Kong Offer Shares and haveprovided all information required in this Application Form, you may
collect your refund cheque(s) and/or share certificate(s) from the Hong
Kong Share Registrar, Computershare Hong Kong Investor Services
Limited at Shops 1712–1716, 17th Floor, Hopewell Centre, 183 Queen’s
Road East, Wanchai, Hong Kong, from 9:00 a.m. to 1:00 p.m. on
Thursday, 2 April 2015 or such other date as notified by us in thenewspapers.

Application by HKSCC Nominees Limited (“HKSCC Nominees”)
thi Application Form is signed by HKSCC Nominees on behalf
Where thisperof persons
who have given electronic application instructions to apply
fo the Hong Kong Offer Shares, the provisions of this Application Formforwhich are inconsistent with those set out in the Prospectus shall not apply
and provisions in the Prospectus shall prevail.
Without limiting the generality of this paragraph, the following sectionsof this Application Form are inapplicable where this form is signed by
HKSCC Nominees:•“Applicants’ declaration” on the first page;•“Warning” on the first page;•“If you are a nominee”;•
All representations and warranties under the “Effect of completingand submitting this Application Form” section, except the first one
regarding registration of Hong Kong Offer Shares in the applicant’sname and the signing of documents to enable the applicant to beregistered as the holder of the Hong Kong Offer Shares;•“If your application for Hong Kong Offer Shares is successful (inwhole or in part)”; and•“Refund of your money”.

The following sections in the “How to Apply for Hong Kong Offer Shares”
section of the Prospectus are inapplicable where this form is signed by
HKSCC Nominees•“How many applications can you make”; and•“Circumstances in which you will not be allotted offer shares”.

如

閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格

株式 社
NIRAKU GC HOLDINGS, INC.*（於日本註冊成立的有限公司）

全 球 發 售••e樣甲. 可提出申請的人士
1. 閣下及 閣下為其利益提出申請的人士必須年滿18歲
並有香港地址。
2. 如 閣下為商號，申請須以個別成員名義提出。
3. 聯名申請人不得超過四名。
4. 如 閣下為法人團體，申請須經獲正式授權人員簽署，並註明其所屬代表身分及蓋上公司印鑑。
5. 閣下必須身處美國境外，並非美國籍人士（定義見S規例），亦非中國法人或自然人。
6. 除《上市規則》批准外，下列人士概不得申請認購任何香港發售股份：• 本公司及 或其任何附屬公司股份的現有實益擁
實益擁有人；• 本公司及 或其任何附屬公司的董事或最高行政
或最高行政
最高行政
人員；
• 上 述 任 何 人 士 的 緊 密 聯 繫 人（定 義 見 上 市 規則）；• 本公司的核心關連人士（定義見上市規則）
或緊
市規
隨全球發售完成後成為本公司核心關連人士的人
為本公司核心關連人士的人
心關連人士；或• 已獲分配或已申請認購任何國際發售股份或以其申請認購任何國際發售股份或以其國際發售股份或以其他方式參與國際發售的人士。
國際發售的人士。
的人士。

及細閱招股章程，提出申請時也僅
細閱招股章程，提出申請
確認 閣下已接獲及細閱招股章程，提出申請時也僅
依據招股章程載列的資料及陳述，而除招股章程任何
列的資料及陳述，而除招股章程任何不會依賴任何其他資料或陳述；
依賴任何其他資料或陳述；
補充文件外，不會依賴任何其他資料或陳述；
確認 閣下知悉招股章程內有關全球發售的限制；下知悉招股章程內有關全球發售的限制；知悉招股章程內有關全球發售的限
同意本公司、獨家全球協調人、獨家保薦人、包銷公司、獨家全球協調人、獨家保薦人、包司、獨家全球協調人、獨家保薦人
商、彼等各自的董事、高級職員、僱員、合夥人、代彼等各自的董事、高級職員、僱員、合夥
彼等各自的董事、高級職員、僱員、合夥人
理、顧問及參與全球發售的任何其他人士現時及日後理、顧問及參與全球發售的任何其他人士現顧問及參與全球發售的任何其他人士現均毋須對並非載於招股章程（及其任何補充文件）
的任（及其任何補（及其任
何資料及陳述負責；
承諾及確認
諾及確認 閣下或 閣下為其利益提出申請的人士
閣下為其利
閣下為其
並無申請或接納或表示有意認購（亦不會申請或接納並無申請或接納或表示有意
或表示有意認購）
或 示有意認購）國際發售的任何發售股份，也沒有
國際發售的
國際發售
參與國際發售；參與 國際發售；際發售；
同意在本公司、香港證券登記處、收款銀行、獨家全
同意在同意在本
本公司、香港本公司、香港證球協調人、獨家保薦人、包銷商及╱或彼等各自的顧
球協調人
球協調人、
獨家保薦
保薦
問及代理
問及代理提出出要
問及代理提出要求時，向彼等披露其所要求提供有閣下為其利益提出申請的人士的個人資
關 閣下
閣下及 閣
料；
若香港境外任何地方的法例適用於 閣下的申請，則若香港境外任若香
同意及保證 閣下已遵守所有有關法例，且本公司、
同意及保獨家全球協調人、獨家保薦人及包銷商和彼等各自的獨家全
高級職員或顧問概不會因接納 閣下的購買要約，
高級或 閣下在招股章程及本申請表格所載的條款及條件項下的權利及責任所引致的任何行動，而違反香港境外的任何法例；
同意 閣下的申請一經接納，即不得因無意的失實陳述而撤銷；
同意 閣下的申請受香港法例規管；
聲明、保證及承諾：(i) 閣下明白香港發售股份不曾亦不會根據美國《證券法》登記；及(ii) 閣下及 閣
下為其利益申請香港發售股份的人士均身處美國境外（定義見 S規例），或屬S規例第902條第(h)(3)段所述的人士；
保證 閣下提供的資料真實及準確；
同意接納所申請數目或根據申請分配予 閣下但數目較少的香港發售股份；
授權本公司將 閣下的姓名╱名稱列入本公司股東名
冊，作為 閣下獲分配的任何香港發售股份的持有人，並授權本公司及╱或其代理以掛號郵遞方式按申
請所示地址向 閣下或聯名申請的首名申請人發送任
何股票及╱或退款支票，如 閣下欲以本身名義登記
將獲發行的香港發售股份，請使用本表格郵誤風險
由 閣下承擔，除非 閣下已選擇親身領取股票及╱或退款支票；

版

•

申請條件

•

m

pl

•

Sa

乙. 如 閣下為代名人
代名人
閣下作為代名人可提交超過一份香港發售股份申請，方法
人可提交超過一份香港發售股份申請，方過一份香港發售股份
是：(i)透過中央結算及交收系統）向香港
過中央結算及交收系統
及交收系 （「中央結算系統」「中央結算
向結算發出電子認購指示；
出電子認購指示
電子認購指示（如閣下為中央結算系統參與者）（如閣下為中央結算系統參
（如閣下為中央結或(ii)使用白色或黃色申請表格，以自身名義代表不同的實
)使用
使用白色
白色或
或 黃色
色 申請表格，以自身名義代申請表格，以自益擁有人提交超過一份申請。
擁有人提交超過一份申請

丙. 填交本申請表格的效用
閣下填妥並遞交本申請表格，即表示
閣下（如屬聯名申填妥並遞交本申請
填妥並遞交本申請表格，即表
請人，即各人共同及個別）
各人共同及個別）人共同及個代表 閣下本身，或作為 閣
下代其行事的每位人士的代理或代名人：
的每位人的每位人士的代理• 承諾促使所有相關文件生效，並指示及授權本公司及╱所有相關文件
有或作為本公司代理的獨家全球協調人（或彼等的代理
代理
或代名人），代表 閣下促使任何文件生效，並為按
照細則的規定將 閣下獲分配的任何香港發售股份
以 閣下名義登記；• 同意遵守公司條例、公司（清盤及雜項條文）條例及細
則；• 確認 閣下已細閱招股章程及本申請表格所載的條款
及條件以及申請程序，並同意受其約束；

•

•
•
•

•
•
•

如
•
•

閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格聲明及表示此乃本人╱吾等為本身或本人╱吾等為其如利益提出申請的人士提出及擬提出的唯一申請；

權任何其他人士代領。如明白本公司及獨家全球協調人將依據人領取，

陳述而決定是否向

閣下的聲明及閣下分配任何香港發售股份，

閣下如作出虛假聲明，可能會被檢控；• （如本申請為

閣下本身的利益提出）保證閣下或作

閣下為個人申請人並合資格親身領取，

閣下不得授

閣下為公司申請人並合資格派

閣下的授權代表須攜同蓋上公司印鑑的授權書

領取。個人申請人及授權代表領取股票時均須出示香港證
券登記處接納的身分證明文件。
如

身領取退款
領取退
閣下並無在指定領取時間內親身領取退款支票及或為閣下代理的任何人士或任何其他人士不曾亦不會

申請表格所示地
請表
股票，有關股票將會立刻寄往本申請表格所示地址，郵誤為閣下的利益以白色或黃色申請表格或向香港結算

風險由

閣下承擔。

或透過白表eIPO服務發出電子認購指示而提出其他,000
00股以下香港發售股份，股以下香港發售股份，
閣下申請認購1,000,000股以下香港發售股份，

閣下

版

如

申請；及
• （如

閣下作為代理為另一人士的利益提出申請）保證

票將於二零一五年四月二日
將於二零一五年四月二日（星期四）的退款支票及╱或股票將於二零一五年四月二日(i)

閣下（作為代理或為該人士利益）或該人士或任何遞方式寄往本申請表格所示地址，郵誤風
往本申請表格所示地址，
或之前以掛號郵遞方式寄往本申請表格所示地址，郵誤風

其他作為該人士代理的人士不曾亦不會以白色或黃色
申請表格或向香港結算發出電子認購指示而提出其他項
退回款項

申請；及(ii)

若，或香港公開發售的條件並無按照「全球發售的架構－「全球
全納，或香港公開發售的條件並無按照發售的條件」一節所述者達成，又或一節所述者達成，又全球發售的條件」

丁. 授權書閣下透過授權人士提出申請，本公司及獨家全球協調

人可按其認為合適的條件（包括出示獲授權證明）酌情接納
納
或拒絕

閣下未獲分配任何香港發售股份或申請僅
未獲分配任何香港發售股份或
閣下未獲分配任何香港發售股份或申請僅部分獲接e樣

閣下獲正式授權作為該人士的代理代

為簽署本表格或發出電子認購指示。

如

擔。
閣下承擔。

險由

閣下的申請。

撤回
回，本公司將不計利息退回，本公司將不計利息退回
撤回，本公司將不計利息退回

閣下的申請被閣下
閣下的申請股款（包括相關的1%%經紀佣金、
紀佣金 0.0027%
0.0027%證監會
證監
關的1%經紀佣金、0.0027%證監會交易徵費及0.005%聯交
交易費 。如最終發售價低於最高發售價，本公司將不
。如最終發售價低
如最終發售價
所交易費）
計 利 息 退 回 多 收 申 請 股 款（包 括 相 關 的 1%經 紀 佣 金 、釐定發售價及香港發售股份的分配0.0027%.0027%證監會交
會 交易徵費0.0027%證監會交易徵費及0.005%聯交所交易費）。
有關退款程序有關退款程序載於招股
有關退款程序載於招股章程「如何申請香港發售股份－ 14.

定。申請人須繳付每股香港發售股份1.28港元的最高發售
28港元的最高發售最高發發送發送╱領取股票及退發送╱領取股票及退回股款」
一節。

pl

預期發售價於二零一五年三月二十七日（星期五）期五）或前後釐釐價，另加1%經紀佣金、0.0027%證監會交易徵費及0.005%
監會交易徵費及費及0.005%
0.005%
聯交所交易費。倘若本公司與獨家全球協調人獨家全球協調人
調人（為其本身及代表包銷商）並無於二零一五年四月一日
一五年四月一日一日（星期三）或之Sam

前協定發售價，全球發售將不會進行並告失效。
將不會進行並告失效。
並告失效截止登記認購申請前，概不處理香港發售股份的申請或配前，概不處理香港發售股份的申請或配處理香港發售股份的申請或配發任何香港發售股份。
股份。

本公司預期於二零一五年四月二日
在南華早報
期於二零一五年四月二日
一五年四月二日（星期四）（星期
在南（英文）、信報（中文）文）、聯交所網站(www.hkexnews.hk)及、聯交所網站
聯交所網站((www.hkex
本公司網站(www.ngch.co.jp.)公佈協定發售價、國際發售
公司網站司網 (www.ngch.co.jp.
o.jj )公佈協定發售公佈協
踴躍程度、香港公開發售認購水平及香港公開發售分配基
踴躍程度、香港公開發售認購水平及香港
躍程度、香港公開發售認購水準。香港公開發售的分配結果以及成功申請人的香港身分
香港公開發售的分配
香港公開發售的分配結果以及成證╱護照╱香港商業登記號碼
（如適用）
亦同於上述網站公照╱香港商業登記號碼
登記
（如
佈。
如

閣下成功申請認購香港發售股份
（全部或部分）請認購香如

閣下申請認購1,000,000股或以上香港發售股份並已提供本申請表格所需一切資料，

閣下可於二零一五年四月

港
香港中央結算（代理人）有限公司（「香港結算代理人」）提出

的申請

如本申
如本申請表格由香港結算代理人代表發出電子認購指示申
請請香
請香港發售股份的人士簽署，本申請表格與招股章程不符
的條文將不適用，且以招股章程所述者為準。
在不限制此段一般應用的前提下，本申請表格的以下部分
在香港結算代理人作簽署人的情況下並不適用：•

第一頁的「申請人聲明」；•

第一頁的「警告」；• 「如閣下為代名人」；• 「填交本申請表格的效用」一節項下的所有陳述及保證，惟首項有關以申請人名義登記香港發售股份及簽
署使申請人登記成為香港發售股份持有人的文件除外；• 「如閣 下 成 功 申 請 認 購 香 港 發 售 股 份（全 部 或 部分）」；及• 「退回款項」。

二日（星期四）或本公司在報章上公佈的其他日期上午九時

招股章程「如何申請香港發售股份」一節的以下部分在香港

正至下午一時正，前往香港證券登記處香港中央證券登記結算代理人作簽署人的情況下並不適用：有限公司（地址為香港灣仔皇后大道東183號合和中心17樓

• 「閣下可提交的申請數目」；及1712-1716室）領取• 「

閣下不獲配發發售股份的情況」。

閣下之退款支票及或股票。

Please use this form if you want the Hong Kong Offer Shares to be issued in your name•

Personal Data
Personal Information Collection Statement
This Personal Information Collection Statement informs
the applicant for, and holder of, Hong Kong Offer Shares,of the policies and practices of the Company and its Hong
Kong Share Registrar in relation to personal data and the
Personal Data (Privacy) Ordinance (Chapter 486 of theLaws of Hong Kong) (the “Ordinance”).

3. Transfer of personal data
Personal data held by the Company
anyy andan its Hong
Ho Kong
Share Registrar relating to thee securities
ecurities holders
hold will be
kept confidential but the Company
mpany
ny and its Hong Kong
Ko ShareS
Registrar may, to the extent
nt necessary for achieving
achievin any ofothe above purposes, disclose,
isclose,sclose, obtain or transfer (whether(w
within or outside Hongg Kong) the personal data to, fromor with any of the
he following:ng:•
the Company’s
financialmpany
pan ’s appointed agents such as fin
financi
advisers,
ers, receiving
eceiving bankers and overseas principal
pr
princ
share
aree registrar;•
wheree applicants for securities request a deposit
intod
CCASS, HKSCC or HKSCC Nominees,
Nomine who willNom
use the personal data for the purposes
purpos of operating
purpo
CCASS;CASS;•
any agents, contractors or third-party
service providers
third-pthi
who
w offer administrative,administrative telecommunications,computer,compputer,ter, payment oro otheroth services to the Company
or the Hong
Hong Kong Share
Sha Registrar in connection withSh
their respective
operation;
respeective business
resp
bus
•
the Stock Exchange,
Excchan the SFC and any other statutory
regulatory
bodies or otherwise as
regulator or governmentalgorequired by laws,
law rules or regulations; and•any persons oro institutions with which the securities’
holdershavehhav or propose to have dealings, such as theirbankers,
bankers solicitors, accountants or stockbrokers etc.

e樣版

1. Reasons for the collection of your personal data
It is necessary for applicants and registered holders of
securities to supply correct personal data to the Company
or its agents and the Hong Kong Share Registrar when
applying for securities or transferring securities into or outof their names or in procuring the services of the Hong
Kong Share Registrar.

any other incidental or associated purposes relating
to the above and/or to enable the Company and theHong Kong Share Registrar to discharge their
obligations to securities’ holders and/or regulators and/or any other purposes to which the securities’ holders
may from time to time agree.

Failure to supply the requested data may result in yourapplication for securities being rejected, or in delay or theinability of the Company or its Hong Kong Share Registrar
to effect transfers or otherwise render their services. It may
also prevent or delay registration or transfers of the Hong
Kong Offer Shares which you have successfully applied
for and/or the dispatch of share certificate(s) and/or refund
cheque(s) and/or e-Refund Payment to which you areentitled.

pl

It is important that securities holders inform the Company
ompanyand the Hong Kong Share Registrar immediately
diately of any
inaccuracies in the personal data supplied.
d.

Sa

m

2. Purposes
The personal data of the securities
es holders may be used,
held, processed, and/or stored (byby whatever means) forf thefollowing purposes:•
processing your application
lication and/oror refund cheque and/or e-Refund Payment
ment , where
ere applicable, verificationof compliancece with the
he terms and application
proceduress set out in thishis Application Form and theProspectusof thetus and announcing
ouncing results of allocation
allo
Hong
g Kong Offer
fer Share
Shares;•complianceinmpliance
pliance with applicable laws and regulations
regu
Hong Kong and elsewhere;•
registering new issues or trainto or out of thetransfers innames of securities’
including, wheresecurities ’ hholders inapplicable, HKSCCHKSC Nominees;•
maintaining
aintaining or updatingup
the register of securities’
holders
rss of the Co
Company;•
verifyingholders’ identities;
g secusecurities hol•
establishingg benefit entitlementsof securities’ holders
eof the Company,
any such as dividends, rights issues,bonus issues, etc.;•
distributing communications from the Company andits subsidiaries;•
compiling statistical information and securities’ holder
profiles;•disclosing relevant information to facilitate claims on
entitlements; and4. Retentionof personal dataRe
The Company
and its Hong Kong Share Registrar will keepCth personal data of the applicants and holders of securities
thefor as long as necessary to fulfil the purposes for which thepersonal data were collected. Personal data which is nolonger required will be destroyed or dealt with in accordancewith the Ordinance.
5. Access to and correction of personal data
Securities holders have the right to ascertain whether theCompany or the Hong Kong Share Registrar hold theirpersonal data, to obtain a copy of that data, and to correct
any data that is inaccurate. The Company and the Hong
Kong Share Registrar have the right to charge a reasonable
fee for the processing of such requests.
All requests for access to data or correction of data should
be addressed to us, at our registered address disclosed in
the section “Corporate Information” in the Prospectus or
as notified from time to time, for the attention of thecompany secretary(ies), or its Hong Kong Share Registrar
for the attention of the privacy compliance officer.
By signing an Application Form or by giving electronic
application instructions to HKSCC, you agree to all of
the above.

如

閣下欲以本身名義登記將獲發行的香港發售股份，請使用本表格

個人資料
個人資料收集聲明
此項個人資料收集聲明是向香港發售股份的申請人和持有人說明有關本公司及其香港證券登記處有關個人資料和香港法例第486章《個人資料（私隱）條例》（「《條例》」）方面的政策和慣例。
1.

收集

閣下個人資料的原因

轉讓或受讓證券時或尋求香港證券登記處的服務時，必須向本公司或其代理人及香港證券登記處
提供準確個人資料。
未能提供所要求的資料可能導致

閣下申請證券

被拒或延遲，或本公司或其香港證券登記處無法落實轉讓或提供服務。此舉也可能妨礙或延遲登記或轉讓 閣下成功申請的香港發售股份及╱或寄發

閣下應得的股票及╱或退款支票及

退款。

或電子
電子

證券持有人所提供的個人資料如有任何錯誤，須
何錯誤，須
須

目的

pl

立即通知本公司及香港證券登記處。
處。
2.

證券持有人的個人資料可被採用及以任何方式持可被採用及以任何方式持
及以任何方有，處理及╱或保存，以作下列用途：，以作下列用途：列用途：
閣下的申請及的申請及或退款支票及m• 處理

3. 轉交個人資料
本公司及其香港證券登記處所持有關證券持有人
所持有關證券
持有的個人資料將會保密，但本公司及其香港證券登但本公司及其香港證
本公司及其香港
記處可以在為達到上述任何目的之必要情況下，述任何目的之必要情述任何目的之必要情況下向下列任何人士披露，獲取或轉交
披露，獲取或轉交
露，獲取或轉交（無論在香港
境內或境外）有關個人資料：
關個人資料：
人資料：• 本公司委任的代理人，例如財務顧問、收款
委任的代理人，例如財務顧問、委任的代理人，例如財務顧問、收款
銀行和主要海外股份過戶登記處；行和主要海外股份過戶登記處；主要海外股份過戶登記處• （如證券申請人要求將證券存於中央結算系
如證券申請人要求將證券存於中央
證券申請人要求將證券存於中央統）
統 香港結算或香港結算代理人，彼等將會
香港結算或香港結算代理
香港結算或香港結算代理人
就中央結算系統的運作使用有關個人資料；
就中央結算系統的運作使用
就中央結算系統的運作使用有• 向本公司或香港證券登記處提供與其各自業
向本公司或香港證券登向本公司或香港證券登記處務營運有關的行政、電訊、電腦、付款或其
務 運有關的行政、電務營運有關的行政、電他服務的任何代理人、承包商或第三方服務
他服 務的任何代理人
務的任何代理供應商；
供應商• 聯交所、證監會及任何其他法定監管機關或政
聯交所、證
聯交所、
證監會
府部門或遵照其他法例、規則或法規；及府部門或府部門或遵照其• 證券持有人與其進行或擬進行交易的任何人
證券持有人證
士或機構，例如彼等的銀行、律師、會計師
士
士或機構
或股票經紀等。
或股票e樣版

證券申請人及登記持有人以本身名義申請證券或• 與上述有關的任何其他附帶或相關目的及╱或使本公司及香港證券登記處能履行對證券
持有人及╱或監管機構承擔的責任及╱或證
券持有人不時同意的任何其他目的。

或電子退款（如適用）如適用）、核實是否符合本申請表格
核實是否符合本申請表格及╱或招股章程載列的條款和申請程序以及或招股章程載列的條款和申請程序以
程載列的條款和申請
公布香港發售股份的分配結果；
布香港發售股份的分配結果
布香港發售股份的分配結果；

Sa• 遵守香港及其他地區的適用法律及法規；遵守香港及其他地區的適用
遵守香港及其他地區的適用法律及• 以 證 券 持 有 人（包包 括 香 港 結 算 代 理 人（如 適的名義登記新發行證券或轉讓或受讓證用））的名義登記新發行證券
的名義登記
券；
；

• 存置或更新本公司證券持有人的名冊；
或更新本公司證更新本• 核實證券持有人的身分；
持有人

4. 個人資料的保留本公司及其香港證券登記處將按收集個人資料所需本
的用途保留證券申請人及持有人的個人資料。無需保留的個人資料將會根據條例銷毀或處理。
5. 查閱和更正個人資料
證券持有人有權確定本公司或香港證券登記處是
否持有其個人資料，並有權索取有關該資料的副
本並更正任何不準確資料。本公司和香港證券登記處有權就處理任何查閱資料的要求收取合理費用。

所有查閱資料或更正資料的要求應按招股章程• 確定本公司證券持有人的受益權利，例如股 「公司資料」一節所披露或不時通知的本公司註冊
息、供股和紅股等；
地址送交公司秘書，或向其香港證券登記處的個• 分發本公司及其附屬公司的通訊；
人資料私隱事務主任提出。
• 編製統計數據和證券持有人資料；
閣下簽署申請表格或向香港結算發出電子認購指• 披露有關資料以便就權益索償；及示，即表示同意上述各項。