无犯罪记录声明

无犯罪记录声明Evidence or A Statement Proving the Person in Charge of the Proposed Representative Office of

表四：首席代表无犯罪记录声明 Form 4:Evidence or AStatement Proving the Person in Charge of the Proposed Representative Office of Overseas Nongovernmental Organizations has No Criminal Record 无犯罪记录声明 Evidence or AStatement Proving the Person in Charge of the Proposed Representative Office of Overseas Nongovernmental Organizations has No Criminal Record I)(Name)(Gender) ( 本人 ,性别 Born in(mm /yy)(Nationality), （（ ） ,出生年月 ,国籍 holder of(ID type)(ID ） ,证件类型 ,证件号码 number) 。 兹声明，本人从未在中国境内及境外有过刑事犯罪记录，愿意遵 守中国的各项法律、行政法规，保证本人的无犯罪记录声明真实 Hereby affirm that Ihave never had any criminal record within or outside the territory （ 有效。 of China, will abide by China’s laws, administrative regulations and guarantee this statement true and valid 。 ） Signature of the Declarant （ ） 声明人： 年月 日 Date: _______________ (dd /mm /yy) 公安部境外非政府组织管理办公室制 Prepared by the Administration Office of overseas NGOs of Ministry of Public Security