<style type="text/css"> .myTable,.myTable td { page-break-after:always; font-family:宋体;font-size:9pt; padding-right:0.5pt; padding-left:0.5pt; padding-top:0.5pt; padding-bottom:0.5pt; border-style:solid;border-width:1px 0 0 1px; } </style> <table cellspacing="0" cellpadding="0" border="0" class="myTable" style="border-width:0;width:555pt"> <tbody><tr style="height:0px"><td style="border-width:0;width:28pt"></td> <td style="border-width:0;width:95pt"></td> <td style="border-width:0;width:87pt"></td> <td style="border-width:0;width:103pt"></td> <td style="border-width:0;width:84pt"></td> <td style="border-width:0;width:76pt"></td> <td style="border-width:0;width:75pt"></td> </tr><tr style="height:55pt"> <td align="center" colspan="7" style="border-width:0"><font style="font-size:22pt;font-weight:bold;">住宅专项维修资金实际使用分摊表</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">一、小区名称</font></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="7"><font style="font-size:14pt;">&nbsp;&nbsp;&nbsp;&nbsp;幸福里</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">二、维修项目概况</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:20pt"> <td values="" style="border-width:0" bindtype="0" rowspan="2" colspan="7" datasource="" type="textarea' styles='line-height:37px"><font style="font-size:14pt;">　　1、幸福里幸福里44*电梯，已维修完毕，结算金额：39,906.00元，审价费用：100<br>0,合计：40,906.00。</font></td> </tr> <tr style="height:20pt"> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">三、施工日期</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　开始日期：2020-07-30；结束日期：2020-08-05。</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">四、施工单位</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　1、无锡日立电梯工程有限公司</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">五、验收结论</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:42pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　合格 <br>&nbsp;&nbsp;验收时间：2020年08月05日</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">六、参与验收人员</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:42pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　华润府幸福里小区物业管理委员会，华润置地（北京）物业管理有限责任公司无<br>锡分公司，无锡日立电梯工程有限公司</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">七、公示时间</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　2021年03月01日至2021年03月01日。</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">八、分摊清册</font></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td align="center">序号</td> <td align="center">房屋地址</td> <td align="center">房屋面积(㎡)</td> <td align="center">结算应拨金额(元)</td> <td align="center">自筹金额(元)</td> <td align="center">分摊金额(元)</td> <td align="center" style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">1</td> <td align="center">幸福里4单元1001室</td> <td align="center">174.3200</td> <td align="center">664.06</td> <td align="center">0</td> <td align="center">664.06</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">2</td> <td align="center">幸福里4单元1002室</td> <td align="center">172.2500</td> <td align="center">656.18</td> <td align="center">0</td> <td align="center">656.18</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">3</td> <td align="center">幸福里4单元1101室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">4</td> <td align="center">幸福里4单元1102室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">5</td> <td align="center">幸福里4单元1201室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">6</td> <td align="center">幸福里4单元1202室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">7</td> <td align="center">幸福里4单元1301室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">8</td> <td align="center">幸福里4单元1302室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">9</td> <td align="center">幸福里4单元1401室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">10</td> <td align="center">幸福里4单元1402室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">11</td> <td align="center">幸福里4单元1501室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">12</td> <td align="center">幸福里4单元1502室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">13</td> <td align="center">幸福里4单元1601室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">14</td> <td align="center">幸福里4单元1602室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">15</td> <td align="center">幸福里4单元1701室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">16</td> <td align="center">幸福里4单元1702室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">17</td> <td align="center">幸福里4单元1801室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">18</td> <td align="center">幸福里4单元1802室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">19</td> <td align="center">幸福里4单元1901室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">20</td> <td align="center">幸福里4单元1902室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">21</td> <td align="center">幸福里4单元2001室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:15pt"> <td align="center">22</td> <td align="center">幸福里4单元2002室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center" style="border-width:1px 0 1px 1px">23</td> <td align="center" style="border-width:1px 0 1px 1px">幸福里4单元201室</td> <td align="center" style="border-width:1px 0 1px 1px">173.6500</td> <td align="center" style="border-width:1px 0 1px 1px">661.51</td> <td align="center" style="border-width:1px 0 1px 1px">0</td> <td align="center" style="border-width:1px 0 1px 1px">661.51</td> <td style="border-width:0 0 0 1px"></td> </tr> </tbody></table> <table cellspacing="0" cellpadding="0" border="0" class="myTable" style="border-width:0;width:555pt"> <tbody><tr style="height:0px"><td style="border-width:0;width:28pt"></td> <td style="border-width:0;width:95pt"></td> <td style="border-width:0;width:87pt"></td> <td style="border-width:0;width:103pt"></td> <td style="border-width:0;width:84pt"></td> <td style="border-width:0;width:76pt"></td> <td style="border-width:0;width:75pt"></td> </tr><tr style="height:14pt"> <td align="center">24</td> <td align="center">幸福里4单元202室</td> <td align="center">171.5800</td> <td align="center">653.62</td> <td align="center">0</td> <td align="center">653.62</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">25</td> <td align="center">幸福里4单元2101室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">26</td> <td align="center">幸福里4单元2102室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">27</td> <td align="center">幸福里4单元2201室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">28</td> <td align="center">幸福里4单元2202室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">29</td> <td align="center">幸福里4单元2301室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">30</td> <td align="center">幸福里4单元2302室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">31</td> <td align="center">幸福里4单元2401室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">32</td> <td align="center">幸福里4单元2402室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">33</td> <td align="center">幸福里4单元2501室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">34</td> <td align="center">幸福里4单元2502室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">35</td> <td align="center">幸福里4单元2601室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">36</td> <td align="center">幸福里4单元2602室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">37</td> <td align="center">幸福里4单元2701室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">38</td> <td align="center">幸福里4单元2702室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">39</td> <td align="center">幸福里4单元2801室</td> <td align="center">174.4600</td> <td align="center">664.61</td> <td align="center">0</td> <td align="center">664.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">40</td> <td align="center">幸福里4单元2802室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">41</td> <td align="center">幸福里4单元2901室</td> <td align="center">174.4600</td> <td align="center">664.60</td> <td align="center">0</td> <td align="center">664.60</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">42</td> <td align="center">幸福里4单元2902室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">43</td> <td align="center">幸福里4单元3001室</td> <td align="center">174.4600</td> <td align="center">664.60</td> <td align="center">0</td> <td align="center">664.60</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">44</td> <td align="center">幸福里4单元3002室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">45</td> <td align="center">幸福里4单元301室</td> <td align="center">173.6500</td> <td align="center">661.51</td> <td align="center">0</td> <td align="center">661.51</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">46</td> <td align="center">幸福里4单元302室</td> <td align="center">171.5800</td> <td align="center">653.62</td> <td align="center">0</td> <td align="center">653.62</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">47</td> <td align="center">幸福里4单元3101室</td> <td align="center">174.4600</td> <td align="center">664.60</td> <td align="center">0</td> <td align="center">664.60</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">48</td> <td align="center">幸福里4单元3102室</td> <td align="center">172.4100</td> <td align="center">656.79</td> <td align="center">0</td> <td align="center">656.79</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">49</td> <td align="center">幸福里4单元3201室</td> <td align="center">170.5000</td> <td align="center">649.51</td> <td align="center">0</td> <td align="center">649.51</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">50</td> <td align="center">幸福里4单元3202室</td> <td align="center">168.4600</td> <td align="center">641.74</td> <td align="center">0</td> <td align="center">641.74</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">51</td> <td align="center">幸福里4单元401室</td> <td align="center">173.8900</td> <td align="center">662.42</td> <td align="center">0</td> <td align="center">662.42</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">52</td> <td align="center">幸福里4单元402室</td> <td align="center">171.8200</td> <td align="center">654.54</td> <td align="center">0</td> <td align="center">654.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">53</td> <td align="center">幸福里4单元501室</td> <td align="center">173.8900</td> <td align="center">662.42</td> <td align="center">0</td> <td align="center">662.42</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">54</td> <td align="center">幸福里4单元502室</td> <td align="center">171.8200</td> <td align="center">654.54</td> <td align="center">0</td> <td align="center">654.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">55</td> <td align="center">幸福里4单元601室</td> <td align="center">174.3200</td> <td align="center">664.06</td> <td align="center">0</td> <td align="center">664.06</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">56</td> <td align="center">幸福里4单元602室</td> <td align="center">172.2500</td> <td align="center">656.18</td> <td align="center">0</td> <td align="center">656.18</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">57</td> <td align="center">幸福里4单元701室</td> <td align="center">174.3200</td> <td align="center">664.06</td> <td align="center">0</td> <td align="center">664.06</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">58</td> <td align="center">幸福里4单元702室</td> <td align="center">172.2500</td> <td align="center">656.18</td> <td align="center">0</td> <td align="center">656.18</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">59</td> <td align="center">幸福里4单元801室</td> <td align="center">174.3200</td> <td align="center">664.06</td> <td align="center">0</td> <td align="center">664.06</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">60</td> <td align="center">幸福里4单元802室</td> <td align="center">172.2500</td> <td align="center">656.18</td> <td align="center">0</td> <td align="center">656.18</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">61</td> <td align="center">幸福里4单元901室</td> <td align="center">174.3200</td> <td align="center">664.06</td> <td align="center">0</td> <td align="center">664.06</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">62</td> <td align="center">幸福里4单元902室</td> <td align="center">172.2500</td> <td align="center">656.18</td> <td align="center">0</td> <td align="center">656.18</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0"></td> <td style="border-width:0"></td> <td align="right" colspan="3" style="border-width:0"><font style="font-size:14pt;">申请人（盖章）</font></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0" colspan="2"><font style="font-size:14pt;">年&nbsp;&nbsp;&nbsp;&nbsp;月&nbsp;&nbsp;&nbsp;&nbsp;日</font></td> </tr> </tbody></table>