PHV LUC SO 03: BAN CUNG CAP THONG TIN APPENDIX 03 CIRRICULLUM VITAE Ban hanh kern theo Thong to so 155/2015/TT-BTC ngay 06 thong 10 nom 2015 caa BO Tai chinh htrang dcin cong bo thong
Trang 1PHV LUC SO 03:
BAN CUNG CAP THONG TIN
APPENDIX 03 CIRRICULLUM VITAE (Ban hanh kern theo Thong to so 155/2015/TT-BTC ngay 06 thong 10 nom 2015 caa
BO Tai chinh htrang dcin cong bo thong tin tren thi truang cherng khocn)
(Promulgated with the Circular No 155/2015/TT-BTC on October 06, 2015 of the
Ministry of Finance guiding the Information disclosure on securities markets)
LONG HOA XA HOI CHU NGHiA VItT NAM
DOc lap - Ty do - Hph phlic
THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness
, ngayifc thong nom 290
, day month year
BAN CUNG CAP THONG TIN/CIRRICULLUM VITAE
Kinh - Oy ban Chirng khoan Nha nu&
- Soy Giao dich chirng khoan
To: - The State Securities Commission
- The Stock Exchange
1/ Ho va ten /Full name: Actaii 744: 1
2/ Gich tinh/Sex: Nye
3/ Ngay thong nom sinhlDate of birth: /13 - 06 - 49'7-3
4/ Novi sinhIPlace of birth: ifu(is _ fate _ vine
5/ SO CMND (ho;dc so h0 chieu)//D card No (or Passport No.): 04 2-9e kb7
Ngay cap/Date of issue (,)L IA4 1 ?At Nth cap/Place of issue
6/ QuOc tichlNationality: V Na#97
7/ Dan tOclEthnic: 0.14.4
riyad '
8/ Dia chi thuang trtilPermanent residence: S'4:3- 3 3_ Pflii Vac r9 Vtat - • —7 — -
9/ SO dintho?ilTelephone number: t216 660 66%
10/ Dia chi email/Email: 73 Aral-e- con,
11/ Chirc vu hien nay tai to chirc la d0i Wong cong b0 thong tinlCurrent, posipon in an
institution subject to information disclosure Rules: U414.62 gill la,
12/ Cac chirc vu hien dang nom gift tai to chirc khacIPositions in others companies: ICIG25-
1
•
Trang 213/ S6 CP nam gift , chiem % von dieu le, trong do:/Number of
shares in possession , accounting for % of registered capital, of which:
+ Dai dien (ten to chic la Nha ntrec/c6 &Ong chitin lugc/th ch*c khac) sa hi-nu/Possess
on behalf of (State/strategic investor/other institution):
+ Ca nhan sa him/ Possess for own account:
14/ Cac cam ket nam gift (neu co)/Other commitment of holding shares (if any): /Cal 15/ Danh sach nguai c6 lien quan cua ngtrai khar/List of related persons of
declarant:
STT
No
Ten ca
nhan/to
chirc/
Name of
individual/
institution
al related
person
S6' CMND/HO chieu (dtii vgi
ca than) hoac SO GCN Bang lcSr doanh nghiep, Gik, pile') hoat dOng hoac giay to phap
VI tuang ducmg (doi vai to chirc), ngay cap, noi cap/
Number of ID or Passport (for individual) or Number of Business Registration, License of Operation or equivalent legal documents (for institution), date of issue,
place of issue
SO luting CP/CCQ nam gill, tS, le sa him tren von dieu le dia
ding ty dai el-lung, quy dai chfing (neu
co)/ Number of
shares/fund certificates in possession, ownership rate of registered capital of the public company, public fund (if any)
IVF6i quan he/
Relationship
P * t/
i
5 4
16/ Lgi ich lien quan d6i vai cong ty dai chung, quy dai chung (neu co)/Related
interest with public company, public fund (if any): ICA.Zy
17/ QuyL lgi mau than vai ding ty dai chung, qu-ydai chung (neu co)/ Conflict
interest with public company, public fund (if any): C.ftwy
Toi cam doan nhitng 16i khai tren day la dimg su th4t, neu sai toi xin hoan town chiu
trach nhiem tnrot phaplu4t// hereby certify that the information provided in this CV
is true and correct and I will bear the full responsibility to the law
NGUIJI KHAI / DECLARANT
(Kj, ghi r5 ho ten) (Signature, full name)
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