Form DI-1: Report on Non-Residents’ Direct Investments in the Country

FORM DI-1 REPORT ON NON-RESIDENTS’ DIRECT INVESTMENTS IN THE COUNTRY BASIC INFORMATION Reporting period Responsible person Period/Year Responsible person’s address INFORMATION ON RESIDENT Responsible person’s e-mail ID number Name of resident Information on the person filling in the form Resident’s office address (street and number) Name and surname Municipality Accounting agency Resident’s status Phone Activity (main activity) E-mail Date of founding Date of entry (dd-mm-yyyy) Type of entity Type of investment INFORMATION ON NON-RESIDENT Name of non-resident Non-resident’s office Country of non-resident Type of entity Non-resident’s activity (main activity) Country of parent company Type of foreign investment Share in capital (in %) BALANCE OF NON-RESIDENT’S EQUITY INVESTMENTS

Name of non-resident Opening balance New balance CAPITAL Initial capital Positive revaluation reserves Unpaid subscribed capital Negative revaluation reserves Issuing premium Undistributed profit from the current period Statutory reserves Loss from the current period Statutory and other reserves Undistributed profit from the previous periods Loss from the previous period TRANSACTIONS Transaction number Type of change Month of transaction Manner of payment Amount 1 2 Total transactions OTHER CHANGES Currency differentials Debt-for-equity swop Amount of other changes State changes Total amount of other changes DIVIDENDS Name of non-resident Passing a decision on dividend payment Dividend payment Paid dividend from the current period Paid retained profit from the previous periods Total Month Year Month Year

(Stamp and signature)