虚拟股份赠与承诺函模板（外籍人士_需考核）__中英文.doc

虚拟股份赠与承诺函Undertaking Letter of Granting Phantom StocksXXX先生/女士Dear Mr./Madam xxx根据《上海xx医疗科技有限公司虚拟股份激励计划管理办法》（以下简称“《管理办法》”）和《上海xx医疗科技有限公司绩效评估管理办法》（以下简称“《评估办法》”）之规定，本公司承诺无偿赠与您【 】股虚拟股份According to the Shanghai United Imaging Healthcare Co. Ltd. Phantom stocks Incentive Plan Management Measures (hereinafter referred to as the Management Measures) and the Shanghai United Imaging Healthcare Co. Ltd Performance Evaluation Management Methods (Hereinafter referred to as the Evaluation Methods), the Company promised to grant you【】 phantom stocks for free.本公司陈述及声明：Statement and Representation of the company在本公司赠与您虚拟股份前，您已阅读、知悉并理解《管理办法》全部之内容，了解虚拟股份并非《公司法》上的真正股权（股份），您仅享有参与公司利润的分配权，您不享有股权（股份）的所有权，无投票权、股东权及其他权利，不具有股东资格，并认可虚拟股份注销的处理以及补偿款支付方式。

Before granting you the phantom stocks. you have read, known and understood all the contents of the Management Measures and understand the phantom stocks is not the share or equity interest as defined in the Company Law of People’s Republic of China. You are entitled to the profit distribution only. You are not entitled to the ownership of equity (shares) and you do not have voting right, shareholder’s rights and other rights. You are not a shareholder and acknowledge the cancellation process and the method of compensation.因本公司拟在中国证券交易所上市，鉴于您的外籍身份，您所持有的虚拟股权现在、未来都将不会在公司登记机关进行登记。

Shanghai United Imaging Healthcare Co. Ltd. intends to be listed on stock exchange in China. In view of your foreign nationality, the phantom stocks held by you are not, and will not be, registered with relevant competent authorities.本公司股东会、董事会及薪酬与绩效评估委员会根据《管理办法》所作出之行为对您具有约束力，您同意并自愿遵守《管理办法》之规定Any actions done by the company’s shareholders’ meeting, the board of directors and the remuneration and performance evaluation committee pursuant to the Management Measures are binding on you, and you agree and are willing to comply with relevant provisions of the Management Measures.您在本函下方签署处签署您本人姓名后，即代表您接受了本公司赠与的虚拟股份，同时也代表接受了本函上述所有内容且无任何异议。

Your signature below means that you accept the granted phantom stocks and accept all abovementioned contents of this Undertaking Letter without any dissents.承诺人：上海xx医疗科技有限公司20 年 月 日Covenantor: Shanghai United Imaging Healthcare Co. Ltd.Date: 受赠人如已阅读本函上述所有内容且无任何异议的，请在如下签署处签名确认： 受赠人（签名）：身份证明文件及号码：日期：If you have read all abovementioned contents of this Undertaking Letter without any dissents, please acknowledge by signing below:Grantee (signature):Nationality:Identification certificate and No.:Date:(Should there be any inconsistencies or conflicts between the English and Chinese version, the Chinese version shall prevail.) 第 3 页。