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Appendix 3 - Template Date of Publication:30/06/2021 Appendix 3 - template Date of publication:30/06/2021 HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause. 14.3.3) (Ar. 14.3.2 i 14.3.3) city where Practice OPTIONAL registered Donations and Grants to HCOs (Ar. 14.1.1) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3.3) TOTAL OPTIONAL Related expenses Sponsorship agreed in the agreements with fee for service HCOs/third or consultancy Registration Travel & parties Fees contract, Fees Accommodation appointed by including travel HCOs to manage & accommodation an Event relevant to the contract INDIVIDUAL NAMED DISCLOSURE-one line per HCP(i.e. all transfers of value during a year for an individual HCP will be summed up:itemization should be available for the Individual Recipient or public authorities' consultation only, as appropriate) Artushenko, Lviv Ukraine 7, Zvodska st. - - 3960,00 3960,00 Mykola 41, Vidinska Baiun, Nataliia Rivne Ukraine - - 21537,62 35141,77 56679,39 str. 69/71, Belatsarkouskaya Odesa Ukraine Rozkydailivska - - 4395,60 4395,60 , Maryna st. Bilozir, Khmelnitskyi Ukraine 1 Pilotska st. - - 3960,00 3960,00 H Kateryna C P s 32 K2 Boichenko, Odessa Ukraine Nezhdanovoi st. - - 5866,58 7260,00 13126,58 Anatolii Odessa 68, Karavaeva Bolbot, Yurii Dnipro Ukraine - - 7920,00 7920,00 st. Bondarenko, Kryvyi Rih Ukraine 2 Katkova 2 st. - - 3960,00 3960,00 Ruslan 20, Shevchenko Chechel, Olena Dnipro Ukraine - - 21537,62 41275,90 62813,52 str. Chekan, Liudmyla Lviv Ukraine 31, Lisnyka st. - - 3960,00 3960,00 HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause. 14.3.3) (Ar. 14.3.2 i 14.3.3) city where Practice OPTIONAL registered Donations and Grants to HCOs (Ar. 14.1.1) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3.3) TOTAL OPTIONAL Related expenses Sponsorship agreed in the agreements with fee for service HCOs/third or consultancy Registration Travel & parties Fees contract, Fees Accommodation appointed by including travel HCOs to manage & accommodation an Event relevant to the contract INDIVIDUAL NAMED DISCLOSURE-one line per HCP(i.e. all transfers of value during a year for an individual HCP will be summed up:itemization should be available for the Individual Recipient or public authorities' consultation only, as appropriate) 9, Mostytska st. Chernenko, Iryna Kyiv Ukraine - - 5866,58 5866,58 Kyiv Chovhan, Elvira Vinnytsa Ukraine 92, Soborna str. - - 15022,56 70975,00 85997,56 Denysenko, 4, Lisoparkova Kharkiv Ukraine - - 7920,00 7920,00 Valerii st. 23-A, 23 Serpnya H Derhachova, Alla Kharkiv Ukraine - - 3960,00 3960,00 C st. P s 1, Bahhavutivska Diadyk, Olena Kyiv Ukraine - - 5715,60 5715,60 st. Dihtiar, 7A, Monastyrska Poltava Ukraine - - 3960,00 3960,00 Hennadii st. Diichuk, Yurii Lviv Ukraine 2a, Hasheka st. - - 12041,74 42881,99 54923,73 Dovhan, Tetiana Vinnytsia Ukraine Soborna str, 84 - - 17465,68 17465,68 83, Avtokrazova Droha, Oleksii Kremenchuh Ukraine - - 21537,62 35141,77 56679,39 str. HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause. 14.3.3) (Ar. 14.3.2 i 14.3.3) city where Practice OPTIONAL registered Donations and Grants to HCOs (Ar. 14.1.1) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3.3) TOTAL OPTIONAL Related expenses Sponsorship agreed in the agreements with fee for service HCOs/third or consultancy Registration Travel & parties Fees contract, Fees Accommodation appointed by including travel HCOs to manage & accommodation an Event relevant to the contract INDIVIDUAL NAMED DISCLOSURE-one line per HCP(i.e. all transfers of value during a year for an individual HCP will be summed up:itemization should be available for the Individual Recipient or public authorities' consultation only, as appropriate) Dubrov, Kyryl Kharkiv Ukraine 2a, L.Maloy st. - - 11880,00 11880,00 Duzha, Tetiana Kyiv Ukraine 11, Lypska st. - - 1980,00 1980,00 21 Akademika Fabryko, Kyiv Ukraine Zabolotnoho st. - - 5866,58 5866,58 Myroslava Kyiv 24, 200 Rokiv Fetysov, Oleh Kherson Ukraine - - 7260,00 7260,00 Khersony st. H C P Filipovych, Vinnitsa Ukraine 15, Poryka st. - - 3960,00 3960,00 s Valerii Gasanov, 114, Get. Mazepa Ivano-Frankivsk Ukraine - - 11880,00 11880,00 Oleksander st. 8, Kondratyka Golovin, Serhii Kyiv Ukraine - - 5154,64 25773,20 30927,84 Yury st. Golyk, Volodymyr Dnipro Ukraine 17, Lomana str. - - 17400,00 17400,00 1/1, Bandery Gonchar, Vanda Khmelnytskyi Ukraine - - 11658,89 11658,89 str. 20a, Pashalina Gutsalo, Dmytro Kyiv Ukraine - - 21537,62 35141,77 56679,39 str. HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause. 14.3.3) (Ar. 14.3.2 i 14.3.3) city where Practice OPTIONAL registered Donations and Grants to HCOs (Ar. 14.1.1) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3.3) TOTAL OPTIONAL Related expenses Sponsorship agreed in the agreements with fee for service HCOs/third or consultancy Registration Travel & parties Fees contract, Fees Accommodation appointed by including travel HCOs to manage & accommodation an Event relevant to the contract INDIVIDUAL NAMED DISCLOSURE-one line per HCP(i.e. all transfers of value during a year for an individual HCP will be summed up:itemization should be available for the Individual Recipient or public authorities' consultation only, as appropriate) 21, Gryshevskogo Havryliuk, Roman Lutsk Ukraine - - 11880,00 11880,00 st. Herasymov, 26, Zabolotnogo Odesa Ukraine - - 3960,00 3960,00 Dmytro st. Hodlevska, 32, Zabolotnogo Odesa Ukraine - - 7260,00 7260,00 Oksana st, Holchenko, 33 Pryvokzalna H Symu Ukraine - - 5866,58 5866,58 C Nataliia st. Symu P s 38, Pushkinska Holod, Oleksandr Kyiv Ukraine - - 24901,29 35141,77 60043,06 str. Holod, Oleksandr Kyiv Ukraine Puhskinska,38 - - 14523,94 6705,22 21229,16 38, Pushkinsta Holod, Oleksandr Kyiv Ukraine - - 36542,08 7691,93 44234,01 str. 38, Pushkinska Holod, Oleksandr Kyiv Ukraine - - 5405,05 5405,05 str. Honcharenko, 12, Chaikovskoho Odessa Ukraine - - 11658,89 11658,89 Yana str. Horbenko, Yurii Mykolaiv Ukraine 1, Kyivska st. - - 7920,00 7920,00 HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause. 14.3.3) (Ar. 14.3.2 i 14.3.3) city where Practice OPTIONAL registered Donations and Grants to HCOs (Ar. 14.1.1) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3.3) TOTAL OPTIONAL Related expenses Sponsorship agreed in the agreements with fee for service HCOs/third or consultancy Registration Travel & parties Fees contract, Fees Accommodation appointed by including travel HCOs to manage & accommodation an Event relevant to the contract INDIVIDUAL NAMED DISCLOSURE-one line per HCP(i.e. all transfers of value during a year for an individual HCP will be summed up:itemization should be available for the Individual Recipient or public authorities' consultation only, as appropriate) 142, Shevchenko Horodyskyi, Oleh Lviv Ukraine - - 7920,00 7920,00 st. 105A, Hrytsenko, Kharkiv Ukraine Traktorobudivnyk - - 3960,00 3960,00 Maryna iv av. 7-K, Peremogy Ishuk, Oleksandr Nova Kahovka Ukraine - - 3960,00 3960,00 st. Ukraine Geroiv H Ivasenko, Yuliya Kyiv Ukraine Stalingrada 2D, - - 16354,89 16354,89 C 579 P s 171, Janelidze, David Kyiv Ukraine Metrolohichna - - 7920,00 7920,00 st. 17/1 Janelidze, David Kyiv Ukraine Metrolohichna - - 5866,58 7920,00 13786,58 st. Kyiv Kalynychenko, Lustdorfska r., Odesa Ukraine - - 16639,71 16639,71 Olena 90V Khilchenko, 48A, Skripnika Kyiv Ukraine - - 17752,16 17752,16 Anastasiia str. 1, Bahhavutivska Khmel, Anna Kyiv Ukraine - - 4620,00 4620,00 st. HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause. 14.3.3) (Ar. 14.3.2 i 14.3.3) city where Practice OPTIONAL registered Donations and Grants to HCOs (Ar. 14.1.1) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3) (Ar. 14.3.3) TOTAL OPTIONAL Related expenses Sponsorship agreed in the agreements with fee for service HCOs/third or consultancy Registration Travel & parties Fees contract, Fees Accommodation appointed by including travel HCOs to manage & accommodation an Event relevant to the contract INDIVIDUAL NAMED DISCLOSURE-one line per HCP(i.e. all transfers of value during a year for an individual HCP will be summed up:itemization should be available for the Individual Recipient or public authorities' consultation only, as appropriate) Pavlivska str, Khmel, Daria Kyiv Ukraine - - 16354,89 16354,89 26/41 25, Kholodkov, Dnipro Ukraine Starokozatska - - 11658,89 77700,00 89358,89 Kostiantyn str. 5, ivana Ogienko Khomyn, Ihor Lviv Ukraine - - 3960,00 3960,00 st. 30/39, H Kitaeva, Iana Kyiv Ukraine Shchekavytska - - 3363,67 3363,67 C P str. s 1, Morshynska Kiyko, Nataliya Lviv Ukraine - - 11658,89 11658,89 str. Kolodii, Bohdan Mukachevo Ukraine 8, Pyrogovo st. - - 2640,00 2640,00 28/1 Viacheslava Kolomoiets, Kyiv Ukraine Chornovola st. - - 5866,58 5866,58 Iryna Kyiv 69B Pekarska st. Kolyada, Ihor Lviv Ukraine - - 5866,58 5866,58 Lviv 27, Malyshka st. Korpiak, Vadym Pliuty Ukraine - - 5866,58 5866,58 Kyiv HCPs: City of Full Name Principal Country of Principal Unique country Costs associated with the Events Fees for service and consultancy Practice HCOs: Principal Practice Address identifier (Sub-clause.
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