1、 - 1 - 附件 实际控制关系账户申报表 ( K-1表 ) Reporting Form for Accounts Involving Actual Control Relationship (Form K-1) 第一部分:申报人信息 Part One: Declarant Information 单位客户 填写信息 For Institutional Client *名称 *Name *交易编码 *Client ID *国家或地区 *Country/ Region *主识别码 * Major Identification Code 联系电话 Tel. 开户会员或境外特殊参与者名称 Memb
2、er/ Overseas Special Participants Name 境外中介名称 (如有) Overseas Intermediary Name (If Any) 客户类型 Client Type A. 生产企业 Producer B. 加工企业 Processing Enterprises C. 贸易公司 Trading Company D. 投资公司 Investment Company E. 其他(请详细说 明) Others (Pls. specify) _ 主营业务 Main Business 是否参与过套期保值交易 ? 是 否 Ever participated in h
3、edging transaction? YesNo 第二部分:实际控制关系账户信息 Part Two: Actual Control Account Information - 2 - 实际控制 关系账户 相关信息 Actual Control Account Information 1、 是否实际控制其他主体(个人或单位客户)的期货交易 ? 是 否 A. Is controlling the futures trading of any individual or institutional client? YesNo 如果是,请根据所控主体的性质填写所控客户的以下相关信息: If yes,
4、 please fill in the following information on the controlled client based on the nature of controlling party: 所控主体为个人客户时:For Controlled Individual: *姓名 *Name *交易编码 *Client ID 国家或地区 Country/ Region 主识别码 Major Identification Code 联系电话 Tel. 开户会员或境外特殊参与者名称 Member/ Overseas Special Participants Name 境外中介名
5、称(如有) Overseas Intermediary Name (If Any) 实际控制 关系描述 Actual Control Relationship Description (请简要描述报告主体与所控主体之间的实际控制关系 ) (Please briefly describe the relationship between the reporting party and the controlled party) 所控主体为单位客户时:For Controlled Institution *名称 * Name *交易编码 *Client ID 国家或地区 Country/ Regi
6、on 主识别码 Major Identification Code 联系电话 Tel. 开户会员或境外特殊参与者名称 Member/ Overseas Special 境外中介名称 (如有) Overseas Intermediary Name (If Any) - 3 - Participants Name 主营业务 Main Business 实际控制 关系描述 Actual Control Relationship Description (请简要描 述报告主体与所控主体之间的实际控制关系 ) (Please briefly describe the relationship betwe
7、en the reporting party and the controlled party) 是否参与过套期保值交易 ? 是 否 Ever participated in hedging transaction? YesNo 2、 是否被其他主体(个人或单位)实际控制期货交易 ? 是 否 如果是,请根据控制主体的性质填写控制客户的以下相关信息: B. Is controlled to other individual or institution regarding futures trading? YesNo If yes, please fill in the following in
8、formation on the controlling client based on the nature of controlling party: 控制主体为个人客户时: For Controlling Individual Client *姓名 * Name 联系电话 Tel. 国家或地区 Country/ Region 主识别码 实际控制 关系描述 Actual Control Relationship Description (请简要描述报告主体与控制主体之间的实际控制关系 ) (Please briefly describe the relationship between t
9、he reporting party and the controlling party) 是否参与过期货交易 ? 是 否 Ever participated in futures trading? YesNo 如果是,请继续填写以下内容: If yes, please fill in the following items: 开户会员或境外特殊参与者名称 Member/ Overseas Special Participants Name 交易编码 Client ID 境外中介名称(如有) Overseas - 4 - Intermediary Name (If Any) 控制主体为单位客户
10、时: For Controlling Institutional Client *名称 * Name 联系电话 Tel. 国家或地区 Country/ Region 主识别码 Major Identification Code 主营业务 Main Business 实际控制 关系描述 Actual Control Relationship Description (请简要描述报告主体与控制主体之间的实际控制关系 ) (Please briefly describe the relationship between the reporting party and the controlling
11、party) 是否参与过期货交易 ? 是 否 Ever participated in futures trading? YesNo 如果是,请继续填写以下内容: If yes, please fill in the following items: 开户会员或境外特殊参与者名称 Member/ Overseas Special Participants Name 交易编码 Client ID 境外中介名 称(如有) Overseas Intermediary Name (If Any) 是否参与过套期保值交易 ? 是 否 Ever participated in hedging transa
12、ction? YesNo 第三部分:申报人承诺 Part Three: Declarant Commitment - 5 - 1.本人承诺所申报内容不存在虚假记载、误导性陈述或者重大遗漏,并对其真实性、准确性、完整性承担个别和连带的法律责任。 A.I hereby certify that no fraud, misleading statement or material omissions in the information provided above, and I agree to take the individual and joint liability for the aut
13、henticity, accuracy and completeness of such information. 2.本人承诺当所申报内容发生变更时,及时履行变更申报义务。 B.I hereby agree to fulfill the notification obligation upon any change occurred to the information I have declared. 3.本人知悉并承诺遵守能源中心关于存在实际控制关系账户的有关规则及要求,合法合规参与期货交易,自愿承担相应的法律责任并接受能源中心的处理措施。 C.I hereby acknowledge
14、and covenant to abide by the Exchanges rules and requirements regarding actual control accounts. I covenant further to take part in futures trading in compliance with relevant laws, regulations and rules, and agree to be subject to any legal liability and the Exchanges measures there under. 注: Note:
15、 1. 标注 “*”的选项为必填项;其他选 项可根据实际情况填写。 A. Items marked with “*” are compulsory; other items are optional. 2. 如报告主体与 1个以上的其他主体存在实际控制关系,则须填写相应数量的实际控制关系账户申报表进行申报,但第一部分内容只填写一次即可。 B. If the actual control relationship exists between the reporting party and more than one other parties, the corresponding number
16、 of “Reporting Form for Accounts Involving Actual Control Relationship” must be filled, except Part One. 3. 主识别码的填写方法:境内个人客户填写身份证号码;境内单位客户填写组织机构代码;境外个人客户填写所在国的护照号码;港澳地区个人客户填写永久性居民身份证;台湾地区个人客户填写有效期内台湾居民来往大陆通行证;境外、港澳台地区的单位客户填写商业登记证。在中国永久居留的境外个人 填写外国人永久居留证。 C. The ways to fill in “Main Identification C
17、ode”: domestic individual clients fill in I.D. number; domestic institutional clients fill in organization code; overseas individual clients fill in the passport number issued by their home country; the individual clients from Hong Kong and Macao fill in Permanent Identity Card; the individual clien
18、ts from Taiwan fill in valid Mainland Travel Permit for Taiwan Residents ; overseas or Hong Kong, Macao and Taiwan institutional clients fill in business registration certificate. The overseas individual citizens with PRCs permanent residence status fill in Foreigners Permanent Residence Card. 申报人:(签字) - 6 - Declarant: (Signature) 年 月 日 Date: