2. Subject-Matter of the Claim 2

FORM - CLAIM

1. CLAIMANT´S IDENTIFICATION DATA

Identification data Name and surname/Business name Kliknutím zadáte text. Permanent residence/ Registered Kliknutím zadáte text. office The official register or other official Kliknutím zadáte text. records and the number of the entry in the register for a legal entity Organization ID no./Birth number Kliknutím zadáte text.

Contact data Contact person Kliknutím zadáte text. Telephone Kliknutím zadáte text. E-mail Kliknutím zadáte text. Mailing address 1 Kliknutím zadáte text.

2. SUBJECT-MATTER OF THE CLAIM 2 Kliknutím zadáte text.

3. LIST OF DOCUMENTS ATTACHED TO THE CLAIM 3 Kliknutím zadáte text.

4. CLAIMANT´S DECLARATION AND CONSENT

. The Claimant hereby confirms that they have read the claim record and it corresponds to the contents of the claim submitted verbally. Furthermore, they confirm the receipt of a counterpart on the date of its execution.

. When settling claims, Centrálny depozitár cenných papierov SR, a.s. (hereinafter referred to as “CDCP”) proceeds in compliance with the Claim Settlement Procedure available at CDCP´s registered office and

Centrálny depozitár cenných papierov SR, a.s. Org. ID: 31 338 976 Banking details ul. 29. Augusta 1/A, 814 80 Bratislava I Tax ID: 2020312833 TATRA BANKA, a.s. registered in the Commercial Register kept by the District Court VAT ID: SK2020312833 IBAN: SK87 1100 0000 002622003416 of Bratislava I, section: Sa, entry no. 493/B www.cdcp.sk BIC: TATRSKBX Telephone: 00421/2/59395110 Fax: 00421/2/ 5296 8755

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website www.cdcp.sk. By attaching their signature, the Claimant confirms that they became familiar with that regulation and relevant information.

. Pursuant to Sec. 11 of Act 122/2013 on Personal Data Protection and amends and complements some other acts, as amended by subsequent regulations (hereinafter referred to as the “Personal Data Protection Act”), the Claimant hereby grants consent to CDCP´s processing of the personal data stated in the claim and all related documents and attachments (it specifically means the name, surname, birth number, permanent residence address, and other submitted data) for the purposes of claim settlement and this for the period of settlement of the claim and the period of time required for records retention stipulated by special legal regulations. Furthermore, the Claimant acknowledges that they are aware of their rights, which they have as the person concerned, set out by Sec. 28 of the Personal Data Protection Act. The Claimant hereby declares that the provided personal data are true and up-to-date.

At Kliknutím zadáte text., on Kliknutím zadáte dátum..

For the Claimant:

identification and signature of the Claimant/ person authorized to act on behalf of the Claimant

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Explanatory notes:

of 4 1 It is to be completed where the Claimant requests delivery of the documents relating to the settlement of the claim to an address other than the registered office/permanent residence address. 2 The claim shall be legible and understandable. The claim contents shall clearly indicate the issue subject to the claim and the remedy sought by the Claimant. 3 The client shall attach all relevant documents proving the correctness of the facts claimed by them to the claim.