中小企业板上市公司股权激励计划草案自查表

　　简称：中顺洁柔               股票代码：002511

　　中小企业板上市公司股权激励计划草案自查表

序号                  事项                                                                                                                                                                                                      是否存在该事项                      备注

                                                                                                                                                                                                                                （是/否/不适用）                        

上市公司合规性要求                                                                                                                                                                                                                                                      

1                     最近一个会计年度财务会计报告是否没有被注册会计师出具否定意见或者无法表示意见的审计报告                                                                                                                    是                                      

2                     最近一个会计年度财务报告内部控制报告是否没有被注册会计师出具否定意见或无法表示意见的审计报告                                                                                                              是                                      

3                     上市后最近36个月内是否不存在未按法律法规、公司章程、公开承诺进行利润分配的情形                                                                                                                            是                                      

4                     是否不存在其他不适宜实施股权激励的情形                                                                                                                                                                    是                                      

5                     是否不存在为激励对象提供贷款以及其他任何形式的财务资助                                                                                                                                                    是                                      

6                     上市公司最近三个月是否不存在以下情形：（1）股东大会或董事会审议通过终止实施股权激励；（2）股东大会未审议通过股权激励计划；（3）未在规定期限内完成授予权益并宣告终止实施股权激励                           是                                      

7                     如上市公司发生《上市公司股权激励管理办法》第七条规定的情形时，方案是否约定终止实施股权激励计划，已获授但尚未行使的权益是否终止行使                                                                        是                                      

8                     上市公司是否拟对内幕信息知情人在股权激励计划草案公告前 6个月内买卖本公司股票及其衍生品种的情况进行自查，是否拟在股东大会审议通过股权激励计划及相关议案后及时披露内幕信息知情人买卖本公司股票的自查报告    是                                      

激励对象合规性要求                                                                                                                                                                                                                                                      

9                     是否不包括单独或合计持有上市公司5%以上股份的股东或实际控制人及其配偶、父母、子女                                                                                                                          是                                      

10                    是否不包括独立董事、监事                                                                                                                                                                                  是                                      

11                    是否不存在最近12个月内被证券交易所认定为不适当人选的情形                                                                                                                                                  是                                      

12                    是否不存在最近12个月内被中国证监会及其派出机构认定为不适当人选的情形                                                                                                                                      是                                      

13                    是否不存在最近12个月内因重大违法违规行为被中国证监会及其派出机构行政处罚或者采取市场禁入措施的情形                                                                                                        是                                      

14                    是否不存在《公司法》规定的不得担任公司董事、高级管理人员的情形                                                                                                                                            是                                      

15                    是否不存在知悉内幕信息而买卖公司股票或泄露内幕信息而导致内幕交易发生的情形                                                                                                                                是                                      

16                    是否不存在其他不适宜成为激励对象的情形                                                                                                                                                                    是                                      

17                    激励对象名单是否经监事会核实                                                                                                                                                                              是                                      

18                    激励对象姓名、职务是否拟在审议股权激励计划的股东大会召开前，通过公司网站或其他途径进行公示，公示期是否拟不少于 10 天                                                                                      是                                      

19                    如激励对象出现《上市公司股权激励管理办法》第八条规定的不得成为激励对象的情形，方案是否约定上市公司不得继续授予其权益，其已获授但尚未行使的权益终止行使                                                    是                                      

 股权激励计划合规性要求                

20    上市公司全部在有效期内的股权激励计划所涉及的标的股票总数累计是否未超过公司股本总额的10%    是        

21    单一激励对象通过全部有效期内的股权激励计划获授的公司股票累计是否未超过公司股本总额的1%     是        

22    预留权益比例是否未超过本次股权激励计划拟授予权益数量的 20%                                 是        

23    股权激励计划的有效期从授权日起计算是否未超过10年                                           是        

股权激励计划披露完整性要求                

24    （1）对照《管理办法》的规定，是否逐条说明上市公司不存在不得实行股权激励以及激励对象不得参与股权激励的情形                                                                                                                                                                                                                                                                                                                                是            

25    （2）股权激励计划的目的、激励对象的确定依据和范围                                                                                                                                                                                                                                                                                                                                                                                        是            

26    （3）股权激励计划拟授予的权益数量及占上市公司股本总额的百分比；若分次实施的，每次拟授予的权益数量及占上市公司股本总额的百分比；设置预留权益的，拟预留的权益数量及占股权激励计划权益总额的百分比；所有在有效期内的股权激励计划所涉及的标的股票总数累计是否超过公司股本总额的10%及其计算方法的说明                                                                                                                                         是            

27    （4）除预留部分外，激励对象为公司董事、高级管理人员的，是否披露其姓名、职务、各自可获授的权益数量、占股权激励计划拟授予权益总量的百分比；是否披露其他激励对象（各自或者按适当分类）的姓名、职务、可获授的权益数量及占股权激励计划拟授出权益总量的百分比；单个激励对象通过全部在有效期内的股权激励计划获授的公司股票累计是否超过公司股本总额 1%的说明                                                                                     是            

28    （5）股权激励计划的有效期，股票期权的授权日、可行权日、行权有效期和行权安排，限制性股票的授予日、限售期和解除限售安排等；若激励计划有授予条件，授予日是否确定在授权条件成就之后                                                                                                                                                                                                                                                          是            

29    （6）限制性股票的授予价格、股票期权的行权价格及其确定方法。如采用《管理办法》第二十三、二十九条规定的方法以外的其他方法确定授予价格、行权价格的，是否对定价依据及定价方式作出说明，独立财务顾问是否就该定价的合理性、是否损害上市公司利益以及对股东利益的影响发表意见                                                                                                                                                                    不适用        

30    （7）激励对象获授权益、行使权益的条件。拟分次授出权益的，是否披露激励对象每次获授权益的条件；拟分期行使权益的，是否披露激励对象每次行使权益的条件。是否明确约定授予权益、行使权益条件未成就时，相关权益不得递延至下期。如激励对象包括董事和高管，是否披露激励对象行使权益的绩效考核指标，同时充分披露所设定指标的科学性和合理性。同时实行多期股权激励计划的，若后期激励计划的公司业绩指标低于前期激励计划，是否充分说明其原因与合理性    是            

31    （8）公司授予权益及激励对象行使权益的程序；是否明确上市公司不得授出限制性股票以及激励对象不得行使权益的期间                                                                                                                                                                                                                                                                                                                              是            

32    （9）股权激励计划所涉及的权益数量、行权价格的调整方法和程序（例如实施利润分配、配股等方案时的调整方法）                                                                                                                                                                                                                                                                                                                                  是            

 33    （10）股权激励会计处理方法、限制性股票或股票期权公允价值的确定方法、涉及估值模型重要参数取值及其合理性、实施股权激励应当计提费用及对上市公司经营业绩的影响                                                                                                                                                          是        

34    （11）股权激励计划变更、终止的条件、需履行的审批程序                                                                                                                                                                                                                                                                是        

35    （12）公司发生控制权变更、合并、分立、激励对象发生职务变更、离职、死亡等事项时如何实施股权激励计划                                                                                                                                                                                                                  是        

36    （13）公司与激励对象各自的权利义务，相关纠纷或争端解决机制                                                                                                                                                                                                                                                          是        

37    （14）上市公司有关股权激励计划相关信息披露文件不存在虚假记载、误导性陈述或者重大遗漏的承诺；激励对象有关披露文件存在虚假记载、误导性陈述或者重大遗漏导致不符合授予权益或行使权益情况下全部利益返还公司的承诺；上市公司权益回购注销和收益收回程序的触发标准和时点、回购价格和收益的计算原则、操作程序、完成期限等    是        

38    （15）上市公司在股权激励计划草案中是否明确规定，自股权激励计划授予条件成就后60日或获得股东大会审议通过股权激励计划之日起60日内（适用于未规定授予条件的情形），按相关规定完成权益授权、登记、公告等相关程序                                                                                                          是        

39    （16）上市公司在股权激励计划草案中是否明确“股权激励计划的实施是否可能导致股权分布不具备上市条件”，存在导致股权分布不具备上市条件可能性的，是否披露解决措施                                                                                                                                                        是        

绩效考核指标是否符合相关要求                

40    是否包括公司业绩指标和激励对象个人绩效指标                                                      是            

41    指标是否客观公开、清晰透明，符合公司的实际情况，是否有利于促进公司竞争力的提升                  是            

42    以同行业可比公司相关指标作为对照依据的，选取的对照公司是否不少于3家                             不适用        

43    是否说明设定指标的科学性和合理性                                                                是            

44    实行多期股权激励计划，后期激励计划的公司业绩指标低于前期激励计划的，是否充分说明原因与合理性    不适用        

限制性股票合规性要求                

45    授权日与首次解除解限日之间的间隔是否不少于1年                                                                                                                                                           是        

46    每期解除限售时限是否不少于 12 个月                                                                                                                                                                      是        

47    各期解除限售的比例是否未超过激励对象获授限制性股票总额的50%                                                                                                                                             是        

48    股票授予价格是否不低于股票票面金额                                                                                                                                                                      是        

49    股票授予价格是否不低于下列价格较高者：（一）股权激励计划草案公布前1个交易日的公司股票交易均价的 50%；（二）股权激励计划草案公布前 20 个交易日、60个交易日或者120个交易日的公司股票交易均价之一的 50%    是        

 股票期权合规性要求                

50    授权日与首次可以行权日之间的间隔是否不少于1年                                                                                                                                         是        

51    股票期权后一行权期的起算日是否不早于前一行权期的届满日                                                                                                                                是        

52    每期行权时限是否不少于12个月                                                                                                                                                          是        

53    每期可行权的股票期权比例是否未超过激励对象获授股票期权总额的50%                                                                                                                       是        

54    行权价格是否不低于股票票面金额                                                                                                                                                        是        

55    行权价格是否不低于下列价格较高者：（一）股权激励计划草案公布前1个交易日的公司股票交易均价；（二）股权激励计划草案公布前20个交易日、60个交易日或者120个交易日的公司股票交易均价之一    是        

独立董事、监事会及中介机构专业意见合规性要求                

56                                                                                                                                                    独立董事、监事会是否就股权激励计划是否有利于上市公司的持续发展、是否存在明显损害上市公司及全体股东利益发表独立意见    是            

上市公司是否聘请律师出具法律意见书，                                                                                                                                                                                                                                                      

并按照《管理办法》的规定对下述事项发表专业意见                                                                                                                                                                                                                                            

57                                                                                                                                                    （1）上市公司是否符合《管理办法》规定的实行股权激励的条件                                                             是            

58                                                                                                                                                    （2）股权激励计划的内容是否符合《管理办法》的规定                                                                     是            

59                                                                                                                                                    （3）股权激励计划的拟订、审议、公示等程序是否符合《管理办法》的规定                                                   是            

60                                                                                                                                                    （4）股权激励对象的确定是否符合《管理办法》及相关法律法规的规定                                                       是            

61                                                                                                                                                    （5）上市公司是否已按照中国证监会的相关要求履行信息披露义务                                                           是            

62                                                                                                                                                    （6）上市公司是否不存在为激励对象提供财务资助的情况                                                                   是            

63                                                                                                                                                    （7）股权激励计划是否不存在明显损害上市公司及全体股东利益和违反有关法律、行政法规的情形                               是            

64                                                                                                                                                    （8）拟作为激励对象的董事或与其存在关联关系的董事是否根据《管理办法》的规定进行了回避                                 是            

65                                                                                                                                                    （9）是否说明其他应当说明的事项                                                                                       是            

66                                                                                                                                                    上市公司如聘请独立财务顾问，独立财务顾问报告所发表的专业意见是否完整、是否符合《管理办法》的要求                      不适用        

审议程序合规性要求                                                                                                                                                                                                                                                                        

67                                                                                                                                                    董事会表决股权激励计划草案时，关联董事是否回避表决                                                                    是            

68                                                                                                                                                    股东大会审议股权激励计划草案时，关联股东是否拟回避表决                                                                是            

69                                                                                                                                                    召开股东大会审议激励计划，独立董事是否就股权激励计划向所有的股东征集委托投票权                                        是            

70                                                                                                                                                    上市公司未按照独立董事或监事会建议聘请独立财务顾问对股权激励计划相关事项发表专业意见的，是否就此事项作特别说明        不适用        

其他合规要求                                                                                                                                                                                                                                                                              

71                                                                                                                                                    股权激励计划是否不存在金融创新及重大无先例事项                                                                        是            

本公司保证所填写的情况真实、准确、完整、合法，并承担因所填写情况有误产生的一切法律责任。                                                                                                                                                                                                  

中顺洁柔纸业股份有限公司董事会（盖章）                                                                                                                                                                                                                                                    

2018年12月【】日