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(((?v???8?w (?w ((?????????D??k??????Tjc ? 0(!??%???%4??%???(???? ? ?v???(!?????????????????????????????????????????????????????????????????????????%?????????D, p:  Application Form for Equipment Donation for the Year _______ China-Africa Science and Technology Partnership Program (CASTEP) Information of the ApplicantName Gender0NationalityAddressZip CodeTel/MobileEmailFaxChinese Institution for Current ResearchResearch FieldStarting Date of Research in ChinaProposed Date of Departure from ChinaReceiving Institution of the EquipmentDestination Port for Equipment Applied (Seaport or Airport)Contact Details of Receiving Party (name, address, tel. number etc.)Applicant?s curriculum vitae, including education background, working experience, research achievement, publications and technical expertise,etc.Descriptions of applicant?s professional occupation in China, including contents of research work, projects that the applicant currently participates in, collaboration and exchanges with Chinese researchers, etc. Descriptions of the proposed research projects to be carried out back in the applicant?s home country, including contents, research durations, the role of the equipment applied in the projects, the involvement of Chinese research institutions, etc. Names and numbers of the equipment applied (Detailed information such as brands and models should be specified in Annex I ) Discription of the plan on the use of the equipment in the applicant?s home countryI declare the information provided above is correct and authentic. Signature above printed name: ____________________ Date: ___________________Reference from Chinese InstitutionName of Institution AddressZip CodeContact PersonPositionTelFaxMobileEmail Recommendation from Chinese Institution: ___________ ___ (Chinese Institution) takes note of this application and hereby recommends the applicant to the Action of Equipment Donation to African Researchers of China-Africa Science and Technology Partnership Program (CASTEP). Signature: (With official stamp of Chinese Institution) Date:  Annex I List of Equipment Applied (Note: The applicant is suggested to apply Equipment that is made in China, with each single piece less than 2m*2m*2m in size, while MOST reserves the right to replace the equipment applied with other brand of similar model or function if necessary) NameModelSizeManufacturer/SupplierUnit Price (pro forma)QuantityTotal Price?RMB ?RemarksTotal Signature above printed name (by the applicant): ________________ (The Official Stamp of the Chinese Reference) Date: ________________ Date: ____________ Annex II Form of Confirmation Name of the Receiving InstitutionAddressZip CodeContact PersonPositionTelFaxEmailIs there an employment contract between the institution and the applicant?Are there any other donations previously granted from the Ministry of Science and Technology (MOST) of the People?s Republic of China? (If yes, please indicate the details.) Discription of the necessity of the equipment with regard to the projects to be carried out by the applicant in the institution.I hereby confirm that our institution will cover any other costs after the transportation of the equipment, including customs duties, costs of installation, necessary consumable materials, repair and maintenance, etc, provide assistance in installation, operation and maintenance, and ensure the proper operation of the equipment. Signature above printed name:____________________________ (by head of the institution, with the Official Stamp) Date: ______________________________ Annex III Personal Statement I declare that I will operate the donated equipment properly and submit to the Ministry of Science and Technology (MOST) of the People?s Republic of China a report on its use $z|?  ( : H V X \ t x z ? ? ? ? ? ? ? ? ? ? ? ? ? ?       ' ) * M V h ?????箥???????????????????????~?~?s????????h2Dh]?CJaJh2DCJaJo(h?N?CJaJo(h]?h]?CJaJo(h]?CJaJh??CJaJo(h]?5?CJPJaJh? Mh? 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