PHU LLJC So 12
APPENDIX 12

BAo cAo KET AUA GIAO DICH C6 PHIEU/CHONG CHiOUY CUA NGIJOI NQI BQ VA
NGI.POI CO LIEN OUAN
REPORI ON RESULTS OF IRANSACI/ON /N SHARES/FUND CERTIFICATES OF INTERNAL PERSOAI AND
AFFILIATED PERSONS
@an henh kdm theo Th6ng tu s6 155/201\/|T-BTC ngdy 06 th6ng 10 nem 2015 cia BO Tdi chinh huong ddn cdng
b6 th1ng tin tren thi trudng chlng khoAn)
(promulgated with the Circular No 15 2U 5/|T-BTC on October 06, 2015 of the Ministry of Finance guiding the
lnformation disclosure on securities markets)

CONG HOA XA HQI CHU NGHIA VIET NAM
D6c lap - Tr,? do - Hanh phtic
THE SOCIALIST REPUBLIC OF VIETNAM

lndependence - Freedom - Happiness
TP.HCM, ngdy 03 theng 07 ndm 2017
......., day ... month ... year.......

BAo cAo KET AUA GIAO DICH CO PHIEU/CHONG CHiOUY CUA NGLTCil NQI BQ COA
c6I.Ic ry oAI cHONG, NGI.PCiI NQI BQ COA OUY DN CHUNG VA NGI.Tq CO LIE].i AUAN
coA NGLrq N9lB9
REPORT ON RESULIS OF IRA'VSA CTION IN SHARES/FUND CERTIFICATES OF INTERNAL PERSON OF
PUBLIC COMPANY, INTERNAL PERSON OF PUBLIC FUND AND RELATED PERSONS OF INTERNAL
PERSO'V

Kinh g&i:

Uy ban Chung khoan Nhe nu6c


lf qu! tqi ngay dang kf giao dich (n5u c6)l Posittion.in the public
company, the fund management company at registration date (if any):Th nh vien HDQT kiem T6ng giem d6c
C6ng ty c6 phAn Thii Kl 21 vd ngay khong cdn la ngudi noi b0 hoAc ngudi c6 liCn quan cia ngudi noi b0 cia
c6ng ty dai ch[ng, c6ng ty quin If qu!: ... ... ... ... ..... (nCu td li do) "l and date on which is no longer internal person
or related person of internal person of the public company, the fund management company:
- Chr?c vu tai c6ng ty dai ch{ng, cong ly quin

*: Mqc ndy chi ddnh cho truing hop chua het thoi han dAng k'i giao dich, d6i tuqng ddng k'i khAng cdn ld nguoi n\i
ngudi c6 li€n quan cia nguoi n1i b0 cia c)ng ty dAi ch1ng, c1ng ty quen li, quy/ This item is only for cases
not yet registration deadline of transaction, the registrant is no longer the internal person or related person of
bO hodc


internal person of the public company, the fund management company.
2. Thong tin ve nguoi n6i b0 cia cong ty dai chLing/quy dai chtng le ngudi c6 lien quan cia c6 nhan/to ch0c thltc
hiCn giao dich (d6ivoi trudng hop ngudi thw hi€n giao dich ld ngusi c6 fien quan cla nguoi n1i b0 cia c1ng ty dai
chung/qui dai chong)l lnformation about internal person of the public company/public fund is related person of
trading individual/organization (in case trader is related person of internal person of the public company/public
fund):

- Ho va ten ngudi noi b1l Name of internal person:

- Qu6c lichl Nationality:
- SO CMND, H6 chi6u, Tha cen cltOc/ lD card/Passpott No.:
- Dia chi thudng

t1l

- OiCn thoai lien h0/


shareslfund ceftificates held before transaction: 649.999 CP - chi€m 3,36%
SO lugng c6 phi6u/ch0ng chi quy deng ky mua/ban/cho/dugc cho/tang/duEc tang/thla k6/chuyCn nhugng/nhan
chuy5n nhuEng/ Number of shares/fund ceftificates registered to purchase/ sale/ give/ be given/ donate/ be
donabd rtnheiU transfer/ tmnsfened: 20.000 CP

6.

7. SO luqng c6 phi6u/ch0ng chi quy afe giao dich (mua/b6n/cho/ttuoc cho/ting/duoc teng/thua telcnuy6n
nhuong/nhin chuyen nhugng/hoan ddi) "*/ Number of shares/fund ceftificates traded (purchase/ sale/ give/ be
given/ donate/ be donated lnheiv transfer/ transferred/swap): 20.0O0 CP
8. SO lwgng, t! 19 cd phieu/chring chi quy nim gio sau khi thL?c hien giao dichl Number, ownership propottion of
shares/fund ceftificates held after executing transaction: 669.999 CP - chiCm 3,4$1/o

9. Phuong thuc giao dichl Mode of transaction: thda thuAn
10. Thoi gian thuc hien giao dich/ Transaction period: ngdy 03107120'17

"" (Trong truong hEp kh6ng thuc
hien h6t so luEng dang ki, nguoi
nOi b0/ nguoi c6 liCn quan phai giai
trinh nguyCn nhan.)l* (ln case of
failing to execute full registered
number, the intemal person/ related
person of internal person shall need
to explain the reasons.)

cA NHANrIO cHOc BAo cAo/
NGUO| OUEC uy OUYEN CoNG B0 THoNG TrN
NAME OF REPORTING ORGANIZATION/
INDIVIDUAU PERSONS AUTHORIZED TO DISCLOSE INFORMATION
q