Issuing Tax Authority: Dalian Hi-tech Park Local Taxation Bureau

Unit: RMB Yuan

Taxpayer’s Name

XXX

Taxpayer’s ID Type

ID Card

Taxpayer’s ID Card No.

210211196304250428

Tax Item

Tax Period

Paid-in Tax Amount

01 - Normal wages and salaries

201001

25,385.77

201002

880.77

201003

880.77

201004

920.77

201005

880.77

201006

3,944.71

201007

1,380.77

201008

1,333.89

201009

1,351.57

201010

1,333.89

201011

1,333.89

201012

1,369.09

Subtotal of normal wages and salaries

201001-201012

40,996.66

Remuneration for personal services

201001-201012

300.00

Total

----

41,296.66

Total tax amount (in uppercase letters)

Forty-one thousand two hundred and ninety-six point double six RMB Yuan

Thank you for your contribution to China’s flourishing and prosperity!

Tax Authority (seal):

Special Seal for Taxation by Dalian Local Taxation Bureau