Appendix No. 1 under Article 10, paragraph 1: Application to claim mutilated or damaged lev banknotes for a deferred exchange to euro

Ordinance No 48 of the BNB Appendix No 1 under Article 10, paragraph 1

APPLICATION FOR Submission of damaged banknotes in levs for deferred exchange for euro

I. Natural Person: The undersigned ........................................................................................................................ with EGN/LNCH ......................... , ID/Passport No. ............................ , date of issue .................. , with current address: town/village ........................................................ , region .............................................., postal code ............, residential complex/street No. ................................................................. , block ......... , entrance ..... , floor .........., apartment ............ , telephone ........................................, e-mail ................................................

II. Legal Entity: .................................................................................. BULSTAT/EIK .............................................. , representative ....................................................................................................................................... , position ..................................................................... , with EGN/LNCH .............................................. , ID/Passport No. .......................... , date of issue ...................... , with correspondence address: town/village ...................................................................................... , region .............................................. , postal code ............, residential complex/street No. ..................................................................................................................... , block .... , entrance ..... , floor .... , apartment ...... , telephone ................... , e-mail ............................... .

III. I submit damaged banknotes from: ☐ my own name and for my own account ☐ the name and for the account of .................................................................................................................... , with current address town/village ......................................................... , region .............................................. , postal code ............, residential complex/street No. ..................................................................................................................... , block .... , entrance ..... , floor .... , apartment ...... , telephone ................... , e-mail ............................... .

IV. Circumstances under which the banknotes were damaged: ................................................................................................................................................................ ................................................................................................................................................................

V. Attached documents: ................................................................................................................................................................ ................................................................................................................................................................

VI. The value of the banknotes exchanged for euro after deduction of applicable fees shall be: ☐ paid in cash at the BNB cash desk in Sofia ☐ transferred to the benefit of ..................................................................................................................... , IBAN/BG/ ..................................................................... , bank code .............................................. , at bank ...................................................................................., branch ................................................ ☐ postal money transfer (as the costs are borne by the claimant) ☐ I wish to receive an evaluation protocol (mark the selected field with an X)

By signing the application, I declare that I am familiar with the information under Article 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation), published by the Bulgarian National Bank on the website www.bnb.bg, in connection with the submission of this application.

Date ............................ . ............................... . (signature)

Ordinance No 48 of the BNB 9 APPLICATION COMPLETION NOTES

Data on the person claiming mutilated or damaged banknotes in levs for a deferred exchange for euro on his own behalf and for his own account are filled under item I. In this case, the field ☐ on behalf of myself and for my own account under item III should be crossed out.

Where damaged or mutilated banknotes are claimed on behalf and for the account of another person, data of the authorised person are filled under item I. In this case, the field ☐ on behalf and for the account of should be crossed out completing the assignee’s data on behalf of whom lev banknotes are claimed for a deferred exchange.

Current address shall mean the address which the person has registered as residence at the time of submitting the application and where he/she receives its correspondence. The current address may not coincide with the permanent address of the person given in his/her identity document.

Where damaged or mutilated banknotes are claimed on behalf and for the account of a legal entity, data thereof should be provided under item II, as well as data of the authorised representative of the legal entity. In this case, item I should not be completed, and the name of the legal entity shall be written down ☐ under item III.

Circumstances under which the banknotes have been damaged or mutilated are described under item IV.

All documents attached to the application shall be listed under item V (a notary certified power of attorney, where the mutilated or damaged lev banknotes are claimed on behalf and for the account of another person; a document issued by a municipal council, a city-hall, a body of the Ministry of Interior or another competent authority about the reasons and circumstances under which the banknote has been damaged or mutilated, if such document can be issued; where lev banknotes have been damaged or mutilated by activated anti-theft devices, the competent authorities should issue a document stating the causes and circumstances under which the respective anti-theft devices have been activated; a financial standing certificate).

The selected field ☐ under item VI should be marked with X by the claimant or the authorised person to specify the way in which he/she would like to receive the amount of the exchanged lev banknotes. When crossing the field ☐ ’transferred in favour of………. (account titleholder) ……… IBAN/BG……...........…. bank code……….................…bank ……..................………. branch, data of the account titleholder should coincide with the data under item III about the person on whose behalf and for whose account the mutilated or damaged lev banknotes have been claimed.

Note: Upon claiming mutilated or damaged lev banknotes for a deferred exchange for euro, they should be packed in a parcel (envelope) protecting its content from further physical and chemical effects and together with the accompanying documents (the application and the documents listed under item V of the application form) placed in same parcel (envelope) which is addressed, as follows: Commission on Evaluation of Mutilated or Damaged Lev Banknotes, BNB Cash Centre, 10, Mihail Tenev Str., 1784 Sofia.

The parcel (envelope) may be submitted at a designated BNB cash desk in Sofia, as well as by parcel postage with advice delivery or by courier.