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gougusqb

By Clara Holmes,2014-05-20 18:22
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gougusqb

Date(日期)

Number of Units

    Subscribed for(应购配股数) Units(配股数)

Total Purchase Price

    ($3.80 per Unit)(应购配股总金额) $

    Taxpayer I.D. Number Signature of Subscriber(签名)

     Capacity in which signed:姓名

     (先填名再填姓)

    Subscriber’s name and business Subscriber’s mailing address Address (please type or print)地址 (if different than business address)

    (先写街道再写城市国家等)

Accepted

EFT BIOTECH HOLDINGSINC.

By

Title

Date

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