辛亥革命博物馆(新馆)建筑设计及首义南轴线

1、辛亥革命博物馆（新馆）建筑设计及首义南轴线城市设计方案国际征集International Design Competition for Xinhai Revolution Museum and South Axis Area of Wuchang Uprising资 格 预 审 申 请 书Pre-Qualification Application 规划设计项目名称：Project Name of Planning： 申请机构(盖章)：Company or Joint Venture Name of Application (Stamp)： 法定代表人或其委托代理人(签字或盖章)： Legal

2、Representative or Attorney （Signature or Stamp）： 地 址（Address）： 日 期（Date）： 年 月 日 报名表Application FormA基本情况Basic Information about Designer1公司注册名称Registered Name of Company or Joint Venture2公司详细资料Detailed Information 法定代理人Legal Representative常驻地址Permanent Address电话Main Telephone传真Fax电子邮箱和网址Email and We

3、bsite公司成立日期Date Established设计资格的种类/级别Qualified Category/Class of Design Practice3本项目联系人People to Contact in this Project 姓名 Name(Mr./Ms.)头衔和职务Title and Position通信地址Mailing Address4商业登记/营业执照Business Operating License登记日期和编号Date License Issued and Registered Number登记地Place of Registration在中国的分支机构登记注册情

4、况（若无，可不填）B公司在相关类似项目中的设计经验Working Experiences and Project History with Similar Scale and NatureProject 1简述项目名称和地点/所承担的设计内容 Brief Description of Project and Design Assignment 合同完成情况和获奖情况 Contract Performance and Awards Received客户/业主情况 Client Information参加人员及其分工 Brief Summary of the Taskforce Dedicated

5、 to this ProjectProject 2Project 3C本项目中拟出任的主要设计人员一Working Experiences and Project History with Similar Scale and Nature姓名Name学历、学位及专业特长Professional Preparation详细任职历史（自现职开始）Appointments (in reverse chronological order)获得的国内或国际奖项Awards, Prizes, and Honors Received设计经验（主要填写相似工程）Synergistic Activities (

6、a list of to thee examples that demonstrate your professional competence in similar project)项目名称Name of Project 1项目规模、特点及性质Project Description项目名称Name of Project 2项目规模、特点及性质Project Description项目名称Name of Project 3项目规模、特点及性质Project Description拟在本项目中担任的职务及责任Proposed Appointment in this ProjectC本项目中拟出任

7、的主要设计人员二Working Experiences and Project History with Similar Scale and Nature姓名Name学历、学位及专业特长Professional Preparation 详细任职历史（自现职开始）Appointments (in reverse chronological order)获得的国内或国际奖项Awards, Prizes, and Honors Received设计经验（主要填写相似工程）Synergistic Activities (a list of to thee examples that demonstra

8、te your professional competence in similar project) 项目名称Name of Project 1 项目规模、特点及性质Project Description项目名称Name of Project 2项目规模、特点及性质Project Description项目名称Name of Project 3项目规模、特点及性质Project Description拟在本项目中担任的职务及责任Proposed Appointment in this ProjectD拟参与本项目的设计师/辅助人员Proposed Staff / Support Staff

9、Dedicated to this ProjectE签字盖章Signature and Stamp我谨代表前述申请参加本次国际征集的设计公司（设计联合体）声明：本表各页，加盖公章为记，所填一切内容属实，并同时在此授权本次竞赛组织者在其认为适当的时间和场合公开、使用有关信息。I certify, as entrusted by the design company (joint design venture), under the laws and regulations of the Peoples Republic of China, that this application as stamped with the seal, and the data and information submitted with it, are all true and correct. I authorize the release of any information i