Addendum No.1

to the Decree of Federal Tax Service of Russian Federation

of November 17, 2010 No. MMB-7-3/611@

(as amended by the Decree of Federal Tax Service of Russian Federation

of December 06, 2011 No. MMB-7-3/909@)

Form No. 2-NDFL

Form code of Classifier of Tax Documents No. 1151078

REFERENCE OF INCOME OF А NATURAL PERSON for the year 2012 No. ХХХХ of May 24, 2013

1. Data about tax agent

1.1. INN/KPP for an organization ХХХХХХХХХ/ХХХХХХХХХ

1.2. Organization name ХХХХХХХХХХ

1.3. OKATO code ХХХХХХХХХХХ

1.4. Telephone number (ХХХ) ХХХХХХ

2. Data about a natural person – recipient of income

2.1. INN - 2.2. Surname, name, patronymic ХХХХХХХХХХХ

2.3. Taxpayer’s status Х 2.4. Date of birth ХХ.ХХ.ХХХХ

2.5. Citizenship (country code) ХХХ 2.6. Code of an identity document Х

2.7. Series and number of an identity document ХХ ХХ ХХХХХХ

2.8. Residential address in Russian Federation: postcode ХХХХХХ region code ХХ

district ХХХ city ХХХХХ locality ХХ

street ХХХХХ house ХХ apartment ХХ

3. Income taxed at the rate of 13%

Month / Income code / Amount of income / Deduction code / Amount of deduction / Month / Income code / Amount of income / Deduction code / Amount of deduction

4. Standard, social and property-related tax deductions

4.1. Amount of tax deductions granted to a taxpayer

Deduction code / Amount of deduction / Deduction code / Amount of deduction / Deduction code / Amount of deduction / Deduction code / Amount of deduction

4.2. No. of Notification confirming the entitlement to property-related tax deduction

4.3. Notification issue date 4.4. Code of the tax authority, which issued the Notification

5. Total amount of income and tax according to results of the tax period at the rate of 13%

5.1. Total amount of income
5.2. Tax base
5.3. Amount of estimated tax
5.4. Amount of withheld tax
5.5. Amount of transferred tax*
5.6. Amount of tax excessively withheld by the tax agent
5.7. Amount of tax not withheld by the tax agent

Tax agent: Chief Accountant (signature) ХХХХХХХХ

* This paragraph is to be filled with respect to the amount of tax calculated on the income received since 2011.

Translated by ХХХХХХХХ. Telephone number ХХХХХХХ.