Translation of Certificate from Pension Fund of Ukraine

Department of executive committee in —

Pension Fund of Ukraine Administration in the town of —.

Town of —

—-

—

— Certificate

Issued to the citizen —-

Place of residence: —-

To certify that he (she) is registered in the Administration of Pension Fund of Ukraine in — receives an oldage pension as a participant in combat operations – article 12 with complete seniority.

1. —- – in the sum of 819,45 hrv.

(eight hundred nineteen hryvnas and 45 kopecks).

Total: 819,45 hrv.

(eight hundred nineteen hryvnas and 45 kopecks).

The certificate is issued to be presented to: at demand.

Head of the Administration Signature –

Specialist Signature –