SUBSCRIPTION AGREEMENT FOR CHINA HOSPITALS, INC. COMMON STOCK ($13.50 PER SHARE)
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SUBSCRIPTION AGREEMENT
FOR
CHINA HOSPITALS, INC.
COMMON STOCK
($13.50 PER SHARE)
Persons interested in purchasing shares of common stock of China Hospitals, Inc. (the "Shares") must complete and return this Subscription Agreement along with their check or money order payable to: CHINA HOSPITALS, INC. (the "Company").
Subject only to acceptance hereof by the Company, in its discretion, the undersigned hereby subscribes for the number of shares of common stock at the aggregate subscription price set forth below.
An accepted copy of this Agreement will be returned to the subscriber as a receipt, and the physical stock certificate will be delivered to each subscriber within thirty days of the final closing of this offering.
Securities Offered
The Company is offering a total of up to 7,500,000 Shares at a price of $13.50 per Share. There is no minimum subscription amount.
Subscription
In connection with this subscription, the undersigned hereby subscribes to the number of Shares shown in the following table.
Number of Shares =
Multiply by Price of Shares × $13.50 per Share
Aggregate Subscription Price = $
In connection with this investment in the Company, I represent and warrant as follows:
- a)
- Prior
to tendering payment for the Shares, I received a copy of and read your prospectus dated [ ], 2005.
- b)
- I
am a bona fide resident of the state
of or a non-US resident.
- c)
- The Company and the other purchasers are relying on the truth and accuracy of the declarations, representations and warranties herein made by the undersigned. Accordingly, the foregoing representations and warranties and undertakings are made by the undersigned with the intent that they may be relied upon in determining his/her suitability as a purchaser. Subscriber agrees that such representations and warranties shall survive the acceptance of subscriber as a purchaser.
1
Please register the Shares, which I am purchasing in the following name(s):
As (check one)
Individual | Tenants in Common | Partnership | ||
Joint Tenants | Corporation | Trust | ||
XXX | Xxxxx with adult custodian under Uniform Gift to Minors Act |
For the person(s) who will be registered shareholder(s):
Signature of Subscriber |
Signature of Co-Subscriber |
|
Name of Subscriber (Printed) |
Name of Co-Subscriber (Printed) |
|
Address of Subscriber |
Address of Co-Subscriber |
|
Address of Subscriber |
Address of Co-Subscriber |
|
Telephone of Subscriber |
Telephone of Co-Subscriber |
|
Subscriber Tax I.D. or Social Security Number |
Co-Subscriber Tax I.D. or Social Security Number |
ACCEPTED BY: China Hospitals, Inc., a Cayman Islands Corporation | ||||
|
Date: | |
||
BY: Xxxxx Xx ITS: CEO |
2
Exhibit 1.3