Izbrisi sva polja

Basic identification number To be filled by legal entity - entrepreneur Activity code Tax identification number

1 Name: Head office ( town; street and number): 2 3

To be filled by the Serbian Business Registers Agency Type of activity Codes

21 22 23 24 25 26

19 20

STATISTICAL ANNEX

I GENERAL DATA ON LEGAL ENTITY I.E. ENTREPRENEUR DESCRIPTION 1 1.Number of mounth in business (mark from 1 to 12) 2. Size mark (mark from 1 to 3) 3. Ownership mark (mark from 1 to 5) 4. Number of foreign (legal entities or natural persons) who have stake in capital 5. Average number of employees at the end of each mounth (whole number) II. GROSS CHANGES OF INTANGIBLE ASSETS AND IMMOVABLES, PLANTS, EQUIPMENT AND BIOLOGICAL RESOURCES Account AD group, DESCRIPTION Gross P account 1 2 3 4 1. Intangible assets 1 1.1. Opening balance 1.2. Increase (purchase) during the year 1.3. Decrease during the year 1.4. Revaluation 1.5. Closing balance (606+607-608+609) 2 2. Immovables, plants, equipment and biological resources 2.1. Opening balance 2.2. Increase (purchase) during the year 2.3. Decrease during the year 2.4. Revaluation 2.5. Closing balance ( 611+612-613+614 ) 606 607 608 609 610 ADP 2 601 602 603 604 605 Current year 3 Previous year 4

in 000 RSD

Value correction 5

Net (col. 4-5) 6

XXXXXXXXXXXX XXXXXXXXXXXX XXXXXXXXXXXX

611 612 613 614 615 XXXXXXXXXXXX XXXXXXXXXXXX XXXXXXXXXXXX

III INVENTORIES' STRUCTURE Account group, DESCRIPTION account 1 2 10 1. Raw material inventories 11 2. Work in process 12 3. Finished products 13 4. Goods 14 5. Permanent assets for sale 15 6. Prepayments 7. TOTAL (616+617+618+619+620+621=013+014)

in 000 rsd

ADP 3 616 617 618 619 620 621 622

Current year 4

Previous year 5

IV CAPITAL STRUCTURE Account group, account 1 300 301 302 303 304 305 309 30

in 000 RSD

DESCRIPTION

ADP 3 623 624 625 626 627 628 629 630 631 632 633

Current year 4

Previous year 5

2 1. Share capital in that : foreign capital 2.Stakes of limited liabilities company in that : foreign capital 3. Stakes of members of partnership and limited partnership in that : foreign capital 4. State capital 5. Socially owned capital 6. Cooperatives' capital 7. Other capital TOTAL (623+625+627+629+630+631 +632=102)

V SHARE CAPITAL STRUCTURE Account group, account 1 1.Common shares part 300 1.1. Number of common shares 1.2. Par value of common shares - total 2. Priority shares 2.1. Number of priority shares 2.2. Par value of priority shares - total 3. TOTAL - Par value of shares (635+637=623) 634 635 636 637 638 DESCRIPTION 2 ADP 3

number of shares as a whole number in 000 RSD

Current year 4

Previous year 5

part 300 300

VI RECEIVABLES AND LIABILITIES Account group, DESCRIPTION account 1 2 1. Receivables derived from sale ( state at the end of the 20 year 639 <= 016) 2. Operating liabilities (state at the end of the year 640 <= 43 119) 3. Receivables for damage compensation from insurance part 228 companies during the year (debit turnover without opening balance) 27 43 450 451 452 4. VAT - previous VAT (yearly amount as per tax reports) 5. Operating liabilities (credit turnover without opening balance) 6. Liabilities for net salaries and wages (credit turnover without opening balance) 7. Liabilities for tax on wages and personel indemnities (credit turnover without opening balance ) 8. Liabilities for contributions on wages and salaries payable by employees (credit turnover without opening balance) 9. Liabilities for dividends, stakes in profit and personel indemnities of the employer (credit turnover without opening balance) 10. Liabilities for indemnities of natural persons derived from contract (credit turnover without opening balance ) 11. Liabilities for VAT (yearly amount as per tax reports) 12. Verified sum ( from 639 to 649 )

in 000 RSD

ADP 3 639 640 641 642 643 644 645 646

Current year 4

Previous year 5

461, 462 and 723

647 648 649 650

465 47

VII OTHER COSTS AND EXPENSES Account group, account 1 513 520 521
522, 523, 524 and 525

in 000 RSD

DESCRIPTION 2

ADP 3 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671

Current year 4

Previous year 5

1. Fuel and energy costs 2. Salaries and compensation costs (gross) 3. Taxes and contributions on wages and salaries costs payable by employer 4. Costs of contribution for natural persons (gross) derived from contracts 5. Compensation costs for members of managing and supervisory board (gross) 6. Other personel indemnities and compensations 7. Production services costs 8. Rental costs 9. Rental costs for land 10. Researches and development costs 11. Depreciation costs 12. Insurance premium costs 13. Payment operations costs 14. Membership fees 15. Tax expenses 16. Contribution expenses 17. Interest expenses 18. Interest expenses and part of financial expenses 19. Interest expenses of loans from banks and other financial organizations 20. Expenses for humanitarian, cultural, educational, scientific and religion purposes, human surrounding's protection and for sport purposes 21. Verified sum ( from 651 to 670 )

526 529 53
533, part 540 and part 525 part 533, part 540 and part 525 536, 537

540 552 553 554 555 556 562

part 560, part 561 and 562 part 560, part 561 and 562 part 579

VIII OTHER INCOME Account group, DESCRIPTION account 1 2 60 1. Revenues from sales of goods 2. Revenues from premiums, subventions, subsidies, 640 recourse, compensations and tax return 641 3. Revenues from conditional donations part 650 4. Revenues from land rent 651 5. Revenues from membership fees
part 660, part 661, 662 part 660, part 661 and part 662 part 660, part 661 and part 669

in 000 RSD

ADP 3 672 673 674 675 676 677 678 679 680

Current year 4

Previous year 5

6. Interest income 7. Interest income from accounts and deposits in banks and other financial organizations 8. Revenues from dividends and stakes in profit 9. Verified sum ( from 672 to 679 )

IX OTHER DATA
in 000 RSD

DESCRIPTION 1 1. Liabilities for excize (as per yearly excize calculation) 2. Calculated customs and other import duties ( total yearly amount as per calculation) 3. Capital subventions and other state allocations for construction and purchase of fixed and intangible assets 4. State allocations for premiums, recourse and coverage of current operating losses 5. Other state allocations 6. Foreign donations and other non-repayable grants in cash or in kind received from foreign legal entities or natural persons 7. Personal indemnities of entrepreneur from net profit (to be filled only by entrepreneurs) 8. Verified sum ( from 681 to 687 )

ADP 2 681 682 683 684 685 686 687 688

Current year 3

Previous year 4

X DEFERRED NEGATIVE NET EFFECTS OF FOREIGN CURRENCY CLAUSES AND EXCHANGE DIFFERENCES
in 000 RSD

DESCRIPTION 1 1. Opening balance of defffered net effect of foreign currency clause 2. Defffered net effect of foreign currency clause 3. Proportionale part of abolished deffered net effect of agreed foreign currency clause 4. Remaining amount of deffered net effect agreed foreign currency clause (no. 1+2-3) 5. Opening balance of deffered net effect of exchange differences 6. Deffered net effect of exchange differences 7. Proportionale part of abolished deffered net effect of exchange differences 8. Remaining amount of deffered net effect of exchange dirrerences (no. 5+6-7)

ADP 2 689 690 691 692 693 694 695 696

Current year 3

Previous year 4

XI DEFERRED POSITIVE NET EFFECTS OF FOREIGN CURRENCY CLAUSES AND EXCHANGE DIFFERENCES
in 000 RSD

DESCRIPTION 1 1. Opening balance of defffered net effect of foreign currency clause 2. Defffered net effect of foreign currency clause 3. Proportionale part of abolished deffered net effect of agreed foreign currency clause 4. Remaining amount of deffered net effect agreed foreign currency clause (no. 1+2-3) 5. Opening balance of deffered net effect of exchange differences 6. Deffered net effect of exchange differences 7. Proportionale part of abolished deffered net effect of exchange differences 8. Remaining amount of deffered net effect of exchange dirrerences (no. 5+6-7) In _____________________, on ____,____20__

ADP 2 697 698 699 700 701 702 703 704

Current year 3

Previous year 4

Person authorized to compose Financial Statement S.P. _______________________

Legal representative

__________________________

The form is prescribed by Rule on contents and form of Financial Statements for legal entities, cooperatives, other legal entities and entrepreneurs ( Official Journal of RS, no. 114/06, 5/07, 119/08, 2/10, 101/12 and 118/12)