NANJING MARITIME COURT

REGISTRATION OF CLAIMS REQUISITION

Applicant: (For a natural person, it shall be listed by her/his NAME, GENDER, DATE OF BIRTH, NATIONALITY, BIRTHPLACE, OCCUPATION/WORKING PLACE, AND DOMICILE; For a legal person or other organizations, it shall be listed by its NAME, DOMICILE, NAME AND POST OF THE LEGAL REPRESENTATIVE/PERSON IN CHARGE. )                                                  

Claims: (The attributes and the sum of the money of the registered claims shall be listed.)

Facts:

Date:                     Issued by:                (Signature)