Translation of Receipt (payment)

Receipt # —-

Date of payment: —- Date of conversion—

Total amount (in words)        Five thousand six hundred and fifty euros 00 cents

Thirty nine thousand and seventy two hryvnias 41 kopecks.

Payer:                                     —-

Payer’s code                          —–

Payer’s bank:             —-BANK, department in —

Payee:                                    —

Code of the payee:                —

Payee’s account:                    —–

Payee’s bank:                        —-BANK, —-

Code of the payee’s bank:    —-

Purpose of payment:              Placing funds to the account in cash

Additional information:

Signatures:

Executor: Signature                Controller_______                  Cashier Signature

Seal

—–BANK