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1、附表 1：编号Attachment 1:Serial Number_2016 年中关村创业团队外籍成员申请在华 永久居留积分评估申报书Application for Permanent Residence in China under the Points Systemfrom Foreign Members of New Venture Teams in Z-Park 2016申报人姓名(Applicant):申报人所在单位 (Company theApplicant Works in):申报人手机号码 (Phone Number of the Applicant):申报人邮箱 E-mail
2、 of theApplicant:单位联系人姓名 Contact Person from the Company:单位联系人电话 Contact Person Phone Number:申报日期(Application Date) :中关村科技园区管理委员会制 Compiled by theAdministrative Committee of Zhongguancun Science Park表.中关村创业团队外籍成员申请在华 永久居留积分评估申报表 Application Form for Permanent Residence in China under the Points Syst
3、em from Foreign Members of New Venture Teams in Z-Park 中文姓名 Chinese Name英文姓名 English Name照片Photo年龄 Age性别 Gender护照号码 Passport NO.出生地 Place of Birth国籍 Nationality在华工作 年限 Number of Years Working in China职务或股权情况 Position or Shareholding Status所符合申报对象标准Criteria Satisfied 工作方式 Mode of Employment 全职 Full t
4、ime 兼职Part time电子邮箱 Email国内住址 Address in China国内电话Phone Numberin China国外单位Employedby WhichCompanyOverseas国外住址Address Overseas国外电话Phone NumberOverseas国外单位职务Position in the Overseas Company 申报单位 Application Filed by (Institution)所在企业基本情况 Basic Information about the Company主营业务范围 Main Business Scope教育教
5、育经历（从本科填起） Education Background (Start from College)时间Time国家Country院校Institute专业Major学位Degree工作经历Work Experience时间 Time国家 Country单位及单位排名或资质情况 Name of Companies You Worked forandTheirRankings/ Qualifications职务 Position团队创业产业发展预期Development Prospect of the Industry Your Team Engaged in团队拥有创新成果/核心技术情况I
6、nnovation Products/Core Technologies Owned by the Team团队企业实际成 长评估 The Companys Real Growth Assessment获得社会投资或投资机构的投资额及占比 Volume and Share of Investment from Private and Institutional Investors in the Companys Total Investment Attracted企业营收及税收情况Company Earnings and Tax所在团队近两年连续投资其他企业情况Continuous Inves
7、tment in Other Companies Made by the Team over the Past Two Years团队创业能力The TeamsEntrepreneurialAbility外籍人本人在团队中发挥作用情况How has the applicant been playing his/her role in the team?团队其他主要成员及情况 Other Key Members of the Team姓名Name职务Position职责分工Division ofResponsibilities学历EducationBackground毕业院校Graduatedf
8、rom曾任职单位及职务PreviousPositionsheldinOtherEstablishments其它获奖情况:Other Honors andAwards：本人承诺以上信息均真实有效。I hereby promise that the above information is true and correct.申报人签字： （印章无效） Signature by theApplicant: (name seals not acceptable)年月日DateMonthYear申报单位意见：Opinions from the institution filing the applica
9、tion:确认以上信息属实，予以推荐。We hereby certify the above information to be true and correct, and offer our recommendation.申报单位（公章）Name of the Institution (official seal)年月日DateMonthYear编号Serial Number_2016 年中关村企业选聘的外籍技术人才 申请在华永久居留积分评估申报书Application for Permanent Residence in China under the Points System from
10、 Foreign Technical Personnel Employed by Z-Park Enterprises 2016申报人姓名(Applicant):申报人所在单位 (Company theApplicant Works in):申报人手机号码 (Phone Number of the Applicant):申报人邮箱 E-mail of theApplicant:单位联系人姓名 Contact Person from the Company:单位联系人电话 Contact Person Phone Number:申报日期(Application Date) :中关村科技园区管理委
11、员会制 Compiled by theAdministrative Committee of Zhongguancun Science Park表.中关村企业选聘的外籍技术人才申请 在华永久居留积分评估申报表 Application Form for Permanent Residence in China under the Points System from Foreign Technical Personnel Employed by Z-Park Enterprises 中文姓名 Chinese Name英文姓名 English Name照片Photo年龄 Age性别 Gender护
12、照号码 Passport NO.出生地 Place of Birth国籍 Nationality在华工作 年限 Number of Years Working in China职务 Position所符合申报对象标准Criteria Satisfied 工作方式 Mode of Employment 全职 Full time 兼职Part time电子邮箱 Email国内住址 Address in China国内电话Phone Numberin China国外单位Employed byWhichCompanyOverseas国外住址Address Overseas国外电话Phone Numbe
13、rOverseas国外单位职务Position in the Overseas Company 申报单位Application Filedby (Institution)企业获得中关 村高新技术企 业证书时间Time ofObtaining theZ-ParkHigh-TechEnterpriseCertificate所在企业基本情况 Basic Information about the Company主营业务范围 Main Business Scope教育教育经历（从本科填起） Education Background (Start from College)时间Time国家Country
14、院校Institute专业Major学位Degree工作经历Work Experience时间 Time国家 Country单位及单位排名或资质情况 Name of Companies You Worked forandTheirRankings/ Qualifications职务 Position综合年薪 Gross Yearly Salary申请人上一年度综合年薪情况（工资+绩效） The Applicants Previous Year Gross Salary (Remuneration Plus Performance Bonus)技术领先性 The Expertise in Tec
15、hnology拥有国际先进创新成果、核心技术，拥有自主知识产权 或专利情况 International advanced innovative products, core technologies, proprietary intellectual property rights or patents owned拥有国际认可的专业技术证书的情况Internationally recognized certificates in professional or technical skills拥有技术成果在中关村企业转化、产业化情况Technological achievements comm
16、ercialized and industrialized at Z-Park enterprises岗位贡献Contributions Made on the Job技术专业情况 Professional Skills技术人才本人在团队中发挥作用情况How has the applicant been playing his/her role in the team?其他获奖说明情况Other Honors and Awards：本人承诺以上信息均真实有效。I hereby promise that the above information is true and correct.申报人签字：（印章无效）Signature by theApplicant: (name seals not acceptable)年月日DateMonthYear申报单位意见：Opinions from the institution filing the application:确认以上信息属实，予以推荐。We hereby certify the
