[01]

To:

[02]

The investor:

Registration/ application for amending the Investment Certificate (No., date of issue, place of issue) with the following contents:

(State the contents stipulated in the Investment Certificate and amendments suggested to be made, if any, in the following items)

[11]

1. Name of the investment project:           

[12]

2. Location for implementation of the project:               ; Land area proposed to use:          

[13]

3. Objectives and scale of the project:          

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4. Invested capital for implementation of the project:          

[15]

In which: Capital contribution to implement the project         

[16]

5. Operational duration:          

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6. Project implementation schedule:          

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7. Proposal for investment incentives:           

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                                                                            THE INVESTOR