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TranslationAppendix4APro-formacapitalverificationreport(exampleprovidedbyCICPA)CapitalVerificationReportTo[Companyname]Weacceptedtheappointmenttoexaminethe[second]installmentofregisteredcapitalcontributionof[Companyname](“theCompany”)asat[date]inrespectofitsapplicationforincorporationandregistration.Theresponsibilitiesofallitsinvestor(s)andtheCompanyaretoensurethatthecapitalcontributionscomplywiththelegalrequirementsoftherelevantlaws,regulations,agreements,contractsandarticlesofassociation;toprovidetrue,legitimateandcompleteinformationfortheverificationofcapitalcontributionsandtosafeguardtheCompany’sassets.Ourresponsibilityistoexpressanopiniononthe[second]installmentofcapitalcontributioninaccordancewiththe“StatementofIndependentAuditingPracticesNo.1:VerificationofCapitalContribution”.Inthecourseofourexamination,weperformedexaminationproceduresasweconsiderednecessaryinthecircumstances.Accordingtotheagreements,contractsandarticlesofassociation,theCompany’sregisteredcapitaltobecontributedby[name](PartyA)and[name](PartyB)is[currency][amount]andshallbefullycontributedin[number]installmentspriorto[date].Thecurrentcontributionisforthe[second]installment,whichshallbecontributedbefore[date].Basedonourexaminationandasat[date],theCompanyhadreceivedcapitalcontributionof[currency][amount]contributedbyPartyAandPartyB.Theaforesaidactualcapitalcontribution[currency][amount]isintheformofcash,[currency][amount]isintheformoftangibleassets,and[currency][amount]isintheformofknow-how.Thecapitalcontributedintheformofknow-howaccountsfor%oftheregisteredcapital.[Inaddition,wealsonotedthatthe[first]installmentofregisteredcapitalcontributionoftheCompany,[currency][amount],ofwhich[currency][amount]wascontributedbyPartyAand[currency][amount]wascontributedbyPartyB,wasverifiedby[name]CertifiedPublicAccountantsCo.,Ltd.withcapitalverificationreport([numberofreport])issuedon[date].Asat[date],theCompanyhasreceivedaccumulatedcapitalcontributionof[currency][amount]intotal.]ThisCapitalVerificationReportisfortheuseoftheCompanytoapplyforitsincorporationandregistrationandtoissueinvestmentcertificate(s)totheinvestor(s).ItisnottobedeemedasaguaranteeoranassuranceoftheCompany’sabilitiesinmaintainingcapital,repayingdebtsoroperatingasagoingconcern.XXXXCertifiedPublicAccountantsandtheCertifiedPublicAccountantswhoperformedthisverificationshallnotbeholdliableforanyconsequencescausedbythemisuseofthisCapitalVerificationReport.AppendixISummaryofthe[Second]InstallmentofCapitalContributionAppendixIISummaryofAccumulatedCapitalContributionAppendixIIINotestoCapitalVerificationReportXXXXCertifiedPublicAccountantsCertifiedPublicAccountantCertifiedPublicAccountantShanghai,thePeople’sRepublicofChina[date]AppendixISummaryof[Second]InstallmentofCapitalContributionAsat[date]Companyname:Nameofcurrencyinwhichregisteredcapitalisexpressed:Monetaryunit:NameofInvestor(s)RegisteredcapitalsubscribedforthecurrentinstallmentThecurrentinstallmentofcapitalcontributionCashTangibleAssetsIntangibleAssetsOthersTotal(expressedinthecurrencyofregisteredcapital)Including:actualcapitalcontributionAmountProportiontototalcapitalsubscribedOriginalcurrencyEquivalentofthecurrencyinwhichtheregisteredcapitalisexpressedOriginalcurrencyEquivalentofthecurrencyinwhichtheregisteredcapitalisexpressedOriginalcurrencyEquivalentofthecurrencyinwhichtheregisteredcapitalisexpressedNameofaccountingfirmperformingthecapitalverification:(Chop)CertifiedPublicAccountant:(Chop)CertifiedPublicAccountant:(Chop)AppendixIISummaryofAccumulatedCapitalContributionAsat[date]Companyname:Nameofcurrencyinwhichregisteredcapitalisexpressed:Monetaryunit:NameofInvestor(s)RegisteredCapitalAccumulatedCapitalContributionBroughtForwardCurrentInstallmentofCapitalContributionAccumulatedCapitalContributionCarriedForwardAmountProportiontoTotalRegisteredCapitalAmountProportiontoTotalRegisteredCapitalAmountProportiontoTotalRegisteredCapitalAmountProportiontoTotalRegisteredCapitalNameofaccountingfirmperformingthecapitalverification:(Chop)CertifiedPublicAccountant:(Chop)CertifiedPublicAccountant:(Chop)1AppendixIIINotestoCapitalVerificationReport1.InformationonapprovalandestablishmentoftheCompanyTheCompanywasjointlyestablishedbyPartyAandPartyBunderapprovalby[competentauthority]evidencedbyapprovaldocument[year]No.[number].Itscertificateofapprovalwasissuedby[nameofissuingentity]on[date]andnumbered[number].TheCompanyobtainedthebusinesslicenseon[date]whichisissuedby[AdministrationofIndustryandCommerce].Theregistrationnumberis[number].2.RegisteredcapitalanditstermsofcontributionInaccordancewiththeapprovedagreements,contractsandarticlesofassociation,theCompany’sregisteredcapitalis[currency][amount].Theregisteredcapitalshallbefullycontributedbytheinvestorsin[number]installmentsbefore[date].Thecurrentcapitalcontributionisforthe[second]installment.PartyAshallcontribute[currency][amount],whichaccountsfor%oftheregisteredcapital,[currency][amount]ofthecontributioniscontributedintheformofcash,[currency][amount]iscontributedintheformoftangibleassetsand[curren