SGE Load-in Application Form for International Members and International Customers Serial Number: Name of applicant Address of applicant Postal code Enterprise category of applicant LBMA accredited producer; Financial institution with international membership on the Exchange; Standard gold ingot/bar manufacturer recognized by the Exchange; or Another organization recognized by the Exchange Legal representative Title Contact person Title Tel Fax Mobile phone E-mail 1. LBMA accredited producer: 1) Proof of the quantity of gold refined in the previous year; 2) Quality commitments; 3) Proof of origin of gold raw materials from non-conflict areas and non-high-risk areas; 4) Copy of trademark registration; 5) Corporate information for identifying gold bullions; 6) Evidence of absence of significant law violations in the past two years; and 7) Other supporting documents related to gold businesses. Supporting documents to be provided 2. Financial institution with international membership on the Exchange: 1) Quality commitments; 2) Proof of origin of gold raw materials from non-conflict areas and non-high-risk areas; and 3) Evidence of absence of significant law violations in the past two years. 3. Standard gold ingot/bar manufacturer recognized by the Exchange: 1) Quality commitments; 2) Proof of origin of gold raw materials from non-conflict areas and non-high-risk areas; and 3) Evidence of absence of significant law violations in the past two years. Announcement This is to certify that we have applied for Load-in qualifications on the Shanghai Gold Exchange voluntarily as an international member/customer and that all the information entered in the Form is true and accurate to the best of our knowledge. Signature of legal representative of applicant Official seal DD/MM/YYYY Note: The serial numbers are to be prepared and provided by the Exchange.