Exhibit 99.3
UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF GEORGIA
ATLANTA DIVISION
| IN RE: | : CHAPTER 11 | |
| : | ||
| CDC CORPORATION, | : CASE NO. 11-79079-PWB | |
| : | ||
| Debtor. | : |
PROOF OF INTEREST (EXCLUSIVE OF COMMON SHARES) IN THE DEBTOR
AND/OR PROOF OF CLAIM AGAINST THE DEBTOR ARISING OUT OF
EMPLOYMENT AGREEMENTS, INDEMNITY AGREEMENTS, INCENTIVE PLANS,
OR OTHER AGREEMENTS, PLANS, CUSTOMS OR PRACTICES
| NOTE: | Youdo not need to complete and file this form to assert an interest in the Debtor arising out of the 35,634,820 shares of Class A common shares of CDC Corporation, the debtor and debtor in possession in the above-captioned case (the “Debtor”), issued and outstanding as of the Debtor’s bankruptcy filing of October 4, 2011, as adjusted for splits (the “Common Shares”). | |
| Use this form if (1) you assert an equity interest, other than a Common Share, in the Debtor, and/or (2) you are a current or former officer, director, manager, and/or employee of the Debtor and/or a direct or indirect subsidiary of the Debtor, and you assert a claim against the Debtor arising out of an employment agreement, indemnity agreement, incentive plan, or other agreement, plan, custom or practice of the Debtor and/or any of its direct and indirect subsidiaries, and you have not previously filed such claim in the Debtor’s above-captioned case. | ||
The undersigned asserts that the undersigned is the holder of the following interest (exclusive of Common Shares) in the Debtor and/or the holder of the following claim against the Debtor arising out of an employment agreement, indemnity agreement, incentive plan, or other agreement, plan, custom or practice of the Debtor and/or any of its direct and indirect subsidiaries:
| 1. | The undersigned holds equity interests in the Debtor (exclusive of Common Shares) as follows: |
| Nature of equity interest(s): | ||
| Date(s) granted: | ||
| Consideration provided for equity interest(s): | ||
| A copy of the documentation on which the equity interest(s) is founded, if any, is attached hereto or cannot be attached for the following reason: | ||
2. The undersigned holds a claim against the Debtorarising out of an employment agreement, indemnity agreement, incentive plan, or other agreement, plan, custom or practice of the Debtor and/or any of its direct and indirect subsidiaries as follows:
| The amount of the claim is $ | . |
| The consideration for this debt (or ground for this liability) owed by the Debtor is as follows: | ||
| The claim arises out of the following: | ||
| A copy of the writing (agreement, plan, etc.) on which the claim is founded, if any, is attached hereto or cannotbe attached for the following reason: | ||
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3. The undersigned is aware that under 18 U.S.C. §§ 152 and 3571, the penalty for presenting a fraudulent claim in a bankruptcy case includes a fine of up to $500,000 or imprisonment for up to five years, or both.
WHEREFORE,the undersigned requests that the Court allow the foregoing interest and/or claim to the undersigned, to be allowed in accordance with the priorities set forth in the Bankruptcy Code.
Dated: , 2012.
| Name of Holder: | ||||
(Print or type) | ||||
| Signed: | ||||
| [If Appropriate] | By: | |||
| As its: | ||||
| Address: | ||||
| Telephone: | ( ) | |||
| Fax: | ( ) | |||
Filing Instructions: The original of this completed form must be filed with the Clerk of the Court at the following address so that it is actually received at or before 4:00 p.m. onNovember 6, 2012 (the “Bar Date”).
Clerk of the Court
United States Bankruptcy Court
75 Spring Street, S.W., Ste. 1340
Atlanta, GA 30303
Proofs of interest and/or claim filed electronically may be filed up to 11:59:59 p.m. on the Bar Date.
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