<p> Application for approval of an asset as collateral for credit S.B1</p><p>Send to [email protected] Numbers in brackets refer to instructions for application form Riksbank’s own note Date (1) Date of arrival(2)</p><p>Applying institution (3) Contact person, - Name, e-mail and telephone (4)</p><p>Issuer</p><p>Issuer (5) Issuer group (6) Issuer’s country of domicile (7)</p><p>Long-term rating (definitive) (8) Fitch(8) Moody's S&P</p><p>Asset ISIN (9) Asset type If government guaranteed assset: (10) Domicile of guarantor(11) Guaranteeing local-government (12)</p><p>Asset rating (definitive) (13) If asset is guaranteed: The guarantor’s rating (14) Fitch Moody's S&P Fitch Moody's S&P</p><p>If asset is covered – does it comply with the requirements in the UCITS-directive (15)</p><p>If asset is guaranteed by local-government – has the local government unlimited taxation rights (16)</p><p>Maturity date (17) Coupon definition (18) Coupon rate (19) Currency (20)</p><p>Outstanding amount (21) Central securities depository (CSD)Country (22) of original registration (23)</p><p>Listed on stock exchange or other regulated market (24) Stock exchange country of domicile(25)</p><p>Applying institution’s relation to issuer (26) Institution is related to issuer WeInstitution herby isconfirm not that the asset does not have subordinated payment rights (subordinated debentures) (27)</p><p> that the information given above is correct (28)</p><p>Signature of the institution (27)</p><p>For the Riksbank’s own notes Liquidity category Group (A/B)</p><p>Comment</p><p>Checked by Price source approved by Registered Controlled</p><p>The Riksbank’s decision  Application approved  Application denied </p><p>Date On behalf of the Riksbank</p><p>Cause</p><p>R I X Forms – S.B1 April 2015</p>