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    KINGDOM OF CAMBODIA

    Nation Religion King

    3

    Form of Disclosure Document for Public

    Issuance of Equity Securities

    (Public Offering)

    2010

    SECURITIES AND EXCHANGE COMMISSION OF CAMBODIA

    No...................................SECC/..........................

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    THE I SSUER AND RELATED ENT ITY W HO PREPARES TH E D ISCLOSURE DOCUM ENT SHALL BE RESPONSIBLE FOR THE

    INFORM AT ION CONTA IN ING IN TH IS D ISCLOSURE DOCUMENT . ............................................................

    (Company name in Khmer, Latin and Code)

    Representatives name of the Issuer: ..............................................................................................

    Address: ..........................................................................................................................................

    Website: ....................................................E-mail: .........................................................................

    Phonenumber: ..........................................Fax number: ...............................................................Company registration number: ..........................Date: ..................................................................

    License number: ..................................................Date: ................................................................

    EQUITY SECURITIES ISSUANCERegistration number: ........................................................................................................... /SECC

    Issued by SECC, Date: ...................................................................................................................

    Underwriter

    .........................................

    (Companys name)

    Co-underwriter (if any)

    .........................................

    (Companys name)

    .........................................

    (Companys name)

    The disclosure and supplementary documents can be obtained at: ................................................

    Date: .....................................

    The person in charge of providing disclosure document:Name: ......................................... Position: ............................. Phone number: ............................

    Fax number: ...................................... Email: ................................................................................

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    Note to Investors

    The Companys directors have approved this disclosure document for public issuance

    of equity securities. The board of director collectively and individually takes full responsibility

    for the accuracy of the information contained in this document. Having made all reasonable

    enquires and to the best of his/her knowledge and belief, the board assures there is no false or

    misleading statement or other facts if omitted would make any statement in this document false

    or misleading.

    The Securities and Exchange Commission of Cambodia (SECC) has approved our

    Public Offering and a copy of this disclosure document has been registered and filed with the

    SECC. The approval and registration of this disclosure document is not an indication that the

    SECC neither recommends to subscribe this securities offering nor assumes responsibility for

    the accuracy of information, opinion or statement contained in this disclosure document.

    The SECC is neither liable for any non-disclosed information and the content of this

    disclosure document, nor certify the accuracy or completeness. The SECC is not liable for any

    loss that investors may suffer from a whole or part of this disclosure document content.

    Investors should rely on his/her own valuations to assess the accuracy and risks related

    to the Public Offering to invest in the company by considering the objective of the investment,

    risk profile, his/her own financial position and so on. If investors have any doubt about this

    disclosure document or in considering the investment, they should consult with securities

    firms, investment advisors, or other professional advisers.

    ............................Date: ........../......../.......... Signature and name of chairman

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    The Tentative Timetable for the Offering

    EventsTentative Date

    dd/mm/yyyy

    Opening date of subscription _ _/_ _/_ _ _ _

    Closing date of subscription _ _/_ _ /_ _ _ _

    Date of subscribed equity securities allotment _ _/_ _ /_ _ _ _

    Date for dispatch of notices of successful applicants _ _/_ _ /_ _ _ _

    Listing date _ _/_ _ /_ _ _ _

    The tentative timetable is subject to change if necessary to facilitate the implementation

    of procedures. The opening date of subscription remains open until [time] p.m. on [day],

    [dd/mm/yy].

    In case of closing date of subscription is delayed and noticed, the date of allotment and

    listing date with permitted securities market would be extended accordingly. The company

    shall notify the public via daily Khmer and English newspapers recognized by the SECC.

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    Definitions, Abbreviations and Technical Terms

    .........................................................................................................................................................

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    TABLE OF CONTENTS

    Note to investors.......................................................................................................................... i

    The tentative timetable for the offering ...................................................................................... ii

    Definitions, abbreviations and technical terms ................................................................... iii

    Section 1 Summary of Disclosure Documents .........................................................1- Companys overview .....................................................................................................2- Business strategies and future plan ................................................................................3- Directors, senior officers and substantial shareholders ..................................................4- Historical financial information .....................................................................................5- Significant factors related to public issuanceof equity securities .................................6- Use of proceeds ..............................................................................................................7- Risk factors ....................................................................................................................8- Dividend policy ..............................................................................................................

    Section 2 Details of Public Offering1- General information of the company .............................................................................2- The information of underwriter(s) .................................................................................3- Percentage of public float and lock-up ..........................................................................4- The information of professional accounting firms and external auditors ......................5- The information of asset valuation company and independent valuers .........................6- The information of lawyers ............................................................................................7- The information of consultants ......................................................................................8- All expenses related to public issuance of equity securities ..........................................9- Description of equity securities being offered ...............................................................10- Determination of offering price of equity securities ......................................................11- Net assets per share, earnings per share, P/E ratio or price earnings multiple per share

    and dividend yield per share ..........................................................................................

    12- Allotment plan of equity securities ...............................................................................13- Use of proceeds ..............................................................................................................14- Investment projects ................................................................................................

    Section 3 Risk Factors ................................................................................................1- Interest rate risks ............................................................................................................2- Exchange rate risks ........................................................................................................3- Industry risks ..................................................................................................................4- Operational risks ............................................................................................................5- Non-operational risks .....................................................................................................6-

    Financial risks including default risks and cash liquidity risks......................................7- Litigation risks and contingent liabilities .......................................................................

    8- Market related risks ........................................................................................................9- Technology related risks ................................................................................................10- Risks related to the changes in rules and regulations .....................................................11- Risks related to the changes in national and international contexts12- Risks related to investments in the securities .................................................................13- Other risks ......................................................................................................................

    Section 4 Companys information ...........................................................................1- Business description .......................................................................................................

    a.

    Company background ................................................................................................

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    b. Business strategies including competitive strength in the market and future plan ...c. Company's main products .........................................................................................d. The sale volume of other products accounted for at least 10% of the companys

    total revenue. .............................................................................................................

    e. Subsidiary, associates and holding company including their core areas of business ......f. Distribution method(s) ..............................................................................................g. Raw materials and other inputs .................................................................................h. Requirements for power, gas and water or other utilities ..........................................i. Customers who purchase goods or services at least 10% of total companys sales ..

    j. Suppliers who supply goods or services at least 10% of total company's purchasesk. Patents, marks, trade names, licenses or other agreements on intellectual property

    rights ..........................................................................................................................

    l. Number of total employees and full-time employees ...............................................m.Potential of production capacity ................................................................................n. Transactions with subsidiary, associates, holding company or related companies ...

    2- Operational plan and financial position .........................................................................a. Profit and cash flow estimated, pro-forma statement of financial position and pro-

    forma consolidated statement of financial position .................................................

    b. Any expectation of significant changes in the number of employees ......................c. Internal and external sources of capital ....................................................................d. Material capital expenditure and expected source of funds for such expenditure ....e. Material changes in income, cost of sales, other operating expenses and net income .......f. Any seasonal aspects of the companys business .....................................................g. Any known trends, events or uncertainties ..............................................................h. Any change in the assets of the company to settle any liability ...............................i. Any material loan between holding company and its subsidiary .............................

    j. Any future contractual and contingent liabilities......................................................k.VAT, income tax, customs duty or other un-paid tax liability including any

    contingent liabilities ..................................................................................................

    l. Operating and finance leases ....................................................................................m.Provisions related to personnel schemes including retirement benefits that would

    not be involved the issuance of equity securities of the company ...........................

    3- Information related to the companys assets ..................................................................a. Property, plant and equipment, biological assets and intellectual properties rights ...

    b. Assets valuation and revaluation (including valuation methods, date of valuation,

    name of independent valuers) ....................................................................................

    Section 5: Information of Companys Directors, Senior Officers and Shareholders ..........

    1- Directors and senior officers ..........................................................................................2-

    Involvement of directors and senior officers in certain legal proceedings ....................3- Remuneration or compensation of directors and senior officers ...................................

    4- Stock options granted to directors, senior officers and employees ................................5- Shareholders ...................................................................................................................

    Section 6: Relationship and transaction(s) with related parties .........................................

    1- Transactions with shareholders for the last 05 (five) years ...........................................2- Material transactions with directors or senior officers ...................................................3- Material transactions with shareholders holding at least 05% of company's outstanding

    shares ..............................................................................................................................

    4- Material transactions with family members of the directors or the senior officers orshareholders holding at least 05% of company's outstanding shares .............................

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    5- Material transactions with persons who has relationship with directors of thecompany, its subsidiary or holding company where the relationship occurred .............

    6- Material transactions with persons who were directors or with any person who hasrelation with the former director of company ................................................................

    7- Material transactions with directors holding any position in an association or non-profit organization or other companies ..........................................................................

    8- Material transactions with directors receiving any interest or professional fee forservices in which director provided via any firm to issuer.........................................

    Section 7: Financial Information ..............................................................................................

    1- Exchange rate .................................................................................................................2- Historical financial information .....................................................................................3- Capitalization and indebtedness .....................................................................................4- Managements discussion and analysis ..........................................................................

    a. Overview of operations .............................................................................................b.Significant factors affecting profit ............................................................................c. Material changes in sales and revenue ......................................................................d. Impact of foreign exchange / interest rates / commodity prices ................................e. Impact of inflation .....................................................................................................f. Government/economics/fiscal/monetary policy

    5- Liquidity and capital resources ......................................................................................a. Working capital .........................................................................................................

    b.Pro forma cash flow ..................................................................................................c. Borrowing ..................................................................................................................d.Breach of terms and conditions of covenants associated with credit arrangement,

    bank loan ...................................................................................................................

    e. Types of financial instruments used ..........................................................................f. Treasury policies and objectives ...............................................................................g.Material commitments ...............................................................................................h.Material litigation and contingent liabilities .............................................................i. Key financial ratios ...................................................................................................j. Trade receivablesk.Inventoriesl.Non-current assetsm.Trade payablesn.Material contracts ......................................................................................................

    6- Trend Information ..........................................................................................................7- Dividend Policy ..............................................................................................................8- Pro-forma financial information ....................................................................................9- Consolidated financial information ................................................................................10- Off-balance sheet ...........................................................................................................

    Section 8: The directors report on the valuation of the companys performance...................

    Section 9: Accountants report..................................................................................................

    Section 10: Other informations..........................................................................................

    1- Resolution of Board of Directors ...................................................................................2- Financial statements audited by internal auditors ..........................................................3- Resolution of shareholders .............................................................................................4- Dividend report ..............................................................................................................5- Report on legal proceeding ............................................................................................

    Section 11: Experts Consent ....................................................................................................

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    Section 12: Subscription Form ..................................................................................................

    Section 13: Signature of Chairman of Board of Directors, Directors, CEO and CFO of

    company ...........................................................................................................................

    Appendix

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    1- Companys overview.........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    2- Business strategies and future plan

    .........................................................................................................................................................

    .........................................................................................................................................................

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    3- Directors, senior officers and substantial shareholders.........................................................................................................................................................

    .........................................................................................................................................................

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    4- Historical financial information

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    .........................................................................................................................................................

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    5- Significant factors related to public issuance of equity securities

    .........................................................................................................................................................

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    .........................................................................................................................................................

    6- Use of proceeds

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    Section 1:Summary of Disclosure Documents

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    7- Risk factors

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    8- Dividend policy

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    1- General information of the companyName of the company: ...................................................................................................................

    Address: ..........................................................................................................................................

    Phone number: .................................................. Fax number: ......................................................

    Website: ............................................................ E-mail: ...............................................................

    Company Registration number: ........................ Date: ..................................................................

    License number: ................................................ Date: ..................................................................

    2- The information of underwriter(s)a- General information of underwriter

    Name of the company: ...................................................................................................................

    Address: .........................................................................................................................................

    Phone number: ..................................................Fax number: .......................................................

    Website: ........................................................... E-mail: ................................................................

    Company registration number: .........................Issued by: ........................... Date: ......................License number issued by SECC: ................................................................. Date: .....................

    b- Co-underwriter (if any)Name of the company: ...................................................................................................................

    Address: ..........................................................................................................................................

    Phone number: ..................................................Fax number: .......................................................

    Website: ........................................................... E-mail: ................................................................

    Company registration number: .........................Issued by: ........................... Date: ......................

    License number issued by SECC: ................................................................. Date: .....................

    c- Underwriting agreement.........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    ........................................................................................................................................................

    d- Underwriters benefits in the company

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    3- Percentage of public floats and lock-up

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    .........................................................................................................................................................

    Section 2:Details of Public Offering

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    4- The information of professional accounting firms and external auditors

    a- Professional accounting firmsName of the company: ...................................................................................................................

    Address: ..........................................................................................................................................

    Phone number: ..................................................Fax number: .......................................................

    Website: ........................................................... E-mail: ................................................................

    Company registration number: .........................Issued by: ........................... Date: ......................License number: .............................................. Issued by: ........................... Date: ..... .................

    Registration number accredited by SECC: ....................................................Date: ......................

    b- External AuditorsName of external auditors: .............................................................................................................

    Address: ..........................................................................................................................................

    Phone number: ..................................................Fax number: .......................................................

    E-mail: ...........................................................................................................................................

    KICPAA membership number: .................................................... Date: ......................................

    Registration number accredited by SECC: ....................................Date: ......................................

    5- The information of asset valuation company and independent valuers

    a- Asset valuation companyName of the company: ...................................................................................................................

    Address: ..........................................................................................................................................

    Phone number: ..................................................Fax number: .......................................................

    Website: ........................................................... E-mail: ................................................................

    Company registration number: .........................Issued by: ........................... Date: ......................

    License Number: ..............................................Issued by: ........................... Date: ......................

    Registration Number accredited by SECC: ...................................................Date: ......................

    b- Independent valuerName of independent valuer: .........................................................................................................

    Address: ..........................................................................................................................................

    Phone number: ......................................................... Fax number: ...............................................

    E-mail: ...........................................................................................................................................

    Professional certificate number : ..............................Issued by: ..................... Date:.....................

    Registration number accredited by SECC: ..................................................... Date: ....................

    6-The information of lawyers

    Name: ............................................................................................................................................Address: .........................................................................................................................................

    Phone number: ......................................................... Fax number: ...............................................

    E-mail: ...........................................................................................................................................

    Professional certificate number: .............................Issued by: ...................... Date:.....................

    Registration number accredited by SECC: ................................................ Date: .........................

    7-The information of consultants (if any)

    Name: .............................................................................................................................................

    Address: ..........................................................................................................................................

    Phone number: ......................................................... Fax number: ...............................................

    E-mail: ...........................................................................................................................................

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    Description of consultants experience: ........................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    8- All expenses related to public issuance of equity securities

    a- Underwriter fees........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Registration of disclosure document fees with SECC........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    c- Listing fees........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    d- Printing and advertising disclosure document fees........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    e- Others........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    9- Description of equity securities being offered

    Name of equity securities: .............................................................................................................

    Class of equity securities: ..............................................................................................................

    Par value per equity securities: ......................................................................................................

    Selling price per equity securities: ................................................................................................

    Total quantity of equity securities being offered: .........................................................................

    Total value of equity securities being offered: ..............................................................................

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    Opening date of subscription: .......................................................................................................

    Closing date of subscription: .........................................................................................................

    Subscription place: .........................................................................................................................

    Allotment/ settlement/ refund date: ...............................................................................................

    Allotment criteria: ..........................................................................................................................

    Description of equity securities: .....................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    10- Determination of offering price of equity securities

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    11- Net assets per share, earnings per share, P/E ratio or price earnings multiple per

    share and dividend yield per share

    a- Net assets per shareNo. Description Amount

    Current assets:

    1

    2

    3

    ...

    Non - current assets:

    1

    2

    3

    ...

    Total assets (A)

    Current liabilities:

    1

    2

    3

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    ...

    Non-current liabilities:

    1

    2

    3

    ... Total liabilities (B)

    Net assets (A-B)

    Number of equity securities (C)

    Net assets per share (A-B) / (C)

    b- Earnings per shareDescription Amount

    Net income after interests and tax (A)

    Dividend paid to preference shares (B)

    (1) = (A) (B)

    Number of common stock outstanding (2)

    Earnings per share (1)/(2)

    c- P/E ratio or price earnings multiple per shareDescription Amount

    Market price per share(1)

    Earnings per share (2)

    Price earnings multiple per share (1)/(2) (Time)

    d- Dividend yield per shareDescription Amount

    Annual dividend per share (1)

    Market price per share (2)

    Dividend yield per share (1)/ (2) (%)

    12- Allotment plan of equity securities

    TypePercentage

    (%)

    Selling price

    per shareQuantity Amount

    Cambodian citizen investors

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    Cambodian citizen investorsand non-Cambodian citizeninvestors

    a- Details for Cambodian citizen investorsInvestors identification

    Percentage

    (%)

    Selling price

    per share Quantity Amount

    Employee

    Individual

    Institution

    b- Details for non-Cambodian citizen investorsInvestors identification

    Percentage

    (%)

    Selling price

    per shareQuantity Amount

    Employee

    Individual

    Institution

    13- Use of proceeds

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    14- Investment projectsa- Name of the investment projects

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Details and duration of the investment projects........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    c- Estimated value of a project and profits realizable from the investment projects........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

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    ........................................................................................................................................................

    d- Risks factors of the investment projects........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    e- Other material relevant information of the investment projects........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

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    1- Interest rate risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

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    2- Exchange rate risksa- Analysis

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    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    3- Industry risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    Section 3: Risk Factors

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    4- Operational risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    5- Non-operational risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    6-Financial risks including default risks and cash liquidity risks

    a- Analysis........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    7-Litigation risks and contingent liabilities

    a- Analysis........................................................................................................................................................

    ........................................................................................................................................................

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    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    8- Market related risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    9- Technology related risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    10- Risks related to the changes in rules and regulationsa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

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    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    11- Risks related to the changes in national and international contexts

    a- Analysis........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    12- Risks related to investments in the securitiesa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    13-Other risksa- Analysis

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Management view and risk mitigation........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

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    1- Business descriptiona- Company background

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    b- Business strategies including competitive strength in the market and future plan........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    c- Companys main productsc-1- Details of products........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    c-2- Details of companys market (domestic or international)

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    d- The sale volume of other products accounted for at least 10% of the companys totalrevenue

    No Products RevenuePercentage to total

    revenue

    1

    2

    3

    ...

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    Section 4:Companys information

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    e- Subsidiary, associates and holding company including their core areas of business

    No. Name Type of relationship Core areas ofbusiness

    Business

    registration date

    1

    2

    3

    ...

    Details: ...........................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    f- Distribution method(s)

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    g- Raw materials and other inputs

    No.Raw material and

    inputs Name and address of suppliers Sources1

    2

    3

    ...

    Details: ...........................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    h- Requirements for power, gas and water or other utilities

    N Input Quantity required Name and address of suppliers

    1 Power

    2 Gas

    3 Water

    4 Others: .................

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    Details: ...........................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    i- Customers who purchase goods or services at least 10% of total companys salesNo. Name of customers

    Type of goods or

    servicesQuantity Total amount

    Contract

    duration

    1

    2

    3

    ...

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    j- Suppliers who supply goods or services at least 10% of total company's purchasesNo. Name of suppliers

    Type of goods or

    servicesQuantity Total amount

    Contract

    duration

    1

    2

    3

    ...

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    k- Patents, marks, trade names, licenses or other agreements on intellectual propertyrights

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    l- Number of total employees and full-time employeesType of employment contract

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    Full time employeesNone-contractual

    employeesTotal

    Type of

    degree

    Ph.D.

    MBA

    BA

    DiplomaCertificate

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    m-Potential of production capacityType of

    production or

    services line

    Licensed capacity Installed capacityActual production

    capacity

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    ........................................................................................................................................................

    n- Transactions with subsidiary, associates, holding company or related companies........................................................................................................................................................

    ........................................................................................................................................................

    .........................................