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Annex IV: On-site Verification Record

On-site V erification Record

No.演出证明申请编号

No. of Application for the Performance Certificate 受理通知书编号No. of Application

Receipt

演出组织者Performance Organizer 演出名称

Name of Performance 演出地点

Venue of Performance

现场核实地点Venue of On-site Verification 现场核实日期Date of On-site Verification

是否演出Performance Staged or not

现场收集资料Documents collected on site 1．表演者名称2．演出节目清单3．演员名单

4．

1. Name of Performer

2. List of programs

3. List of artists

4.

说明：

Notes:

演出组织者或其授权代表签章：现场核实人员签章：

2010年月日Signature/seal of the performance organizer or its authorized representative:

Signature/seal of on-site verification personnel:

__/__/2010 The documents collected on site provided in attachments shall bear the signature/seal of the performance organizer and the on-site verification personnel.

This form shall be kept by the Bureau of Shanghai World Expo Coordination.