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16.06.95 N 34

1 2008 ()

12
 
   --------------------------T------------------T-------T--------T------------------T------T------------
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   +-------------------------+------------------+-------+--------+------------------+------+------------+
              1                    2              3       4               5           6       7       
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   +-------------------------+--------------------------------------------------------------------------+
   --------------------------T-T-T-T-T-T-T-T---T-T------------T-T-T-T-T-T-T-T---T- ------------
                                                                     
   L------------------------L-+-+-+-+-+-+-+-+--L-+-+--L---------L-+-+-+-+-+-+-+-+--L-+-- L------------
          --T-T-T-T- --<*>                                                                          
                                                                                        
          L-+-+-+-+-- L--                                                                             
   L-------------------------+---------------------------------------------------------------------------





                                                       N 11
                                                         /Annex N 11/
                                                          
                                                  /to the Regulation/
                                       
                                           /of the State Tax Service/
                                                  
                                          /of the Russian Federation/
                                                      16.06.95 N 34
                                               /from    1995 N      /

     ( .     31.12.1997 N -6-06/928)

   ---------------- ----------------------------------------------------
     X XX X                     
   L--L--L--L--L--L--L--L-- Fields are filled by block letters                 
                            L----------------------------------------------------

   
   To the Claimant ______________________________________________________________
           
   Double Taxation Convention between the Russian Federation and ________________
   ----------------------T--------------------------------------------T---------
     1013DT(1997)                  CLAIM                       
                    for--
    Form 1013DT (1997)                199 
   the State Tax Service                  L--
         of Russia      for an exemption incomes sourced in Russia           
                                 before the payment is made                  
   +---------------------+--------------------------------------------+---------+
   1.   (Foreign entity)                                        
                              --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                                             
          Name in full        L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                              --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                                                      
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                              --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                                           
    Full residential address  L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                               ------------------  <*>          --T-
                              Country                  Country code <*>   
                                     L------------------                  L-+--
   +----------------------------------------------------------------------------+
         --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
    Identification tax number                         
   in country of registratioinL-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
   2.  ,                          
      Authorized representative if any                                         
                                                                               
       ,    ------------------------------------------------
        ,                                                        
      Name, address, phone                                                   
                              L------------------------------------------------
   +----------------------------------------------------------------------------+
                           --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
    Identification tax number                         
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
   3.                                                 
      Information about source of income                                       
                                                                               
                     ------------------------------   <**> --T-
         Type of income                                     Number <**>   
                              L------------------------------             L-+--
   +----------------------------------------------------------------------------+
                                                                               
                  -  --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
         Contractor                               
                                    L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                            Name    --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                            in full                      
                                    L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                               ------------------------------------
                            Full address                                     
                                                                             
                                          L------------------------------------
                                         --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                            Identification                   
                            tax number      L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                        -----------------------  --T-T-T-T-T-
         Contract            Number                        Date       
                                    L-----------------------      L-+-+-+-+-+--
   +------------------------------------------------------------T---------------+
             --T-T-T-T-T-T-T-T-T-T-T-                       
    <***>           A                                    
   Total income in whole      L-+-+-+-+-+-+-+-+-+-+-+--           <*>
   currency units <***>                                           Currency    
   +------------------------------------------------------------+    code <*>   
    ,                                         --T-T-    
           --T-T-T-T-T-T-T-T-T-T-T-                   
                      B                         L-+-+--    
   Amount of tax to be        L-+-+-+-+-+-+-+-+-+-+-+--                       
   withheld at basic rate                                                     
   +------------------------------------------------------------+---------------+
    ,    --T-T-T-T-T-T-T-T-T-T-T-       --T-
       C                     Tax Rate     
   Tax under the Treaty       L-+-+-+-+-+-+-+-+-+-+-+--                   L-+--
   +-------------------------------------------------------T---------------------
     ,               --T-T-T-T-T-T-T-T-T-
   (. B - . C)                                                
   Total tax not subject to withholding                   L-+-+-+-+-+-+-+-+-+--
   (line B - line C)                                      
   L--------------------------------------------------------

     _____   Enclosures on _____ pages

       --------------------------------
       <*>   "BIG directory".  By  reference  book  "BIG
   directory".
       <**>             . 2.
   Order number in the List of the types of income on page 2.
       <***>         .   Can   be
   specified an approximate ammount.

   ----------------
     X XXX 
   L--L--L--L--L--L--L--L--
     Form 1013DT (1997)                           . Page 2
   ___________________________________________________________________----------
      , :                                                            
      I declare that                                                           
      -                      
    ;                                                       
        the above  mentioned income is not connected with activities           
   carried in the Russian Federation                                           
      -                          
   ;                                                                    
        the recipient  of  the  above income is being the beneficial           
   owner                                                                       
                                                                               
          .                  
      I hereby  confirm  that  the  information provided herewith is           
   accurate                                                                    
     -----------------        -----------------------------------   
                                                          Occupation 
                       Stamp L-----------------------------------            
                             -----------------------------------         
                                                                    Name   
                             L-----------------------------------            
     L-----------------        -----------------------------------     
                                                                   Signature 
                               L-----------------------------------            
                               --T-T-T-T-T-                               
                                      Date                              
                               L-+-+-+-+-+--                                   
   +----------------------------------------------------------------------------+
   4.          
      Note of the foreign Tax authority                                        
   +----------------------------------------------------------------------------+
      ,          
                                                              
      It is hereby confirmed that the claimant is a resident of _______________
   ____________________________________________________________________________
                        / name of the country                    
                  /
                                                          
      in the sense implied in the Double Taxation Convention between the USSR /
      Russian Federation and                                                   
   ____________________________________________________________________________
                        / name of the country                    
                                                                               
             ----                                     
          The claimed incomes are           
          taxable                    L----      ( ----)
     -----------------    ---- in the country                 X  
                       not taxable     of residence            (mark L----)
                                   L----                                     
                                                                             
                       ---------------------------------    
                       Stamp                                     
     L-----------------        L---------------------------------Date and Place
                               ---------------------------------       
                                                                  Signature  
                               L---------------------------------              
   +-----------------------------------------------T-----------------------------
       List of types of income
   +--T--------------------------------------T-----+----------------------------
   N                                          Type               
   +--+--------------------------------------+----------------------------------+
   01                             Dividends                         
   02               Income from underwriting shares   
   03     ..Income from investment funds etc. 
   04    Interest from corresponding       
                                     accounts                          
   05             Interest from credits             
   06            Interest from deposits            
   07        Interest from corporate bonds     
                                                                   
   08      Interest from state bonds         
                                                                   
   09 ()        Interest (discount) from notes    
                                                                     
   10         Interest from other paper         
                                                                      
   11         Interest from penalties           
   12  ()         Royalties                         
   13   ()   Income from leasings of movable   
                                  property                          
   14   ()            Income from leasings of real      
                       estate                            
   15           Premiums from direct insurance and
                              coinsurance                       
   16               Premiums from reinsurance         
   17                  Interest on depo of premiums      
   18                          Other income                      
   L--+--------------------------------------+-----------------------------------



   ---------------- ----------------------------------------------------
     XX X                       
   L--L--L--L--L--L--L--L-- Fields are filled by block letters                 
                            L----------------------------------------------------

       
   For Claimant's foreign Tax authority _________________________________________
           
   Double Taxation Convention between the Russian Federation and ________________
   ----------------------T--------------------------------------------T---------
     1013DT (1997)                 CLAIM                       
                    for--
    Form 1013DT (1997)                199 
   the State Tax Service                  L--
         of Russia      for an exemption incomes sourced in Russia           
                                 before the payment is made                  
   +---------------------+--------------------------------------------+---------+
   1.   (Foreign entity)                                        
                              --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                                             
          Name in full        L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                              --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                                                      
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                              ------------------------------------------------
                                                                  
    Full residential address  L------------------------------------------------
                               ------------------  <*>          --T-
                              Country                  Country code <*>   
                                     L------------------                  L-+--
   +----------------------------------------------------------------------------+
         --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-  
    Identification tax number                          
   in country of registratioinL-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--  
   +----------------------------------------------------------------------------+
   2.  ,                          
      Authorized representative if any                                         
                                                                               
       ,    ------------------------------------------------
        ,                                                        
      Name, address, phone                                                   
                              L------------------------------------------------
   +----------------------------------------------------------------------------+
                           --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-  
    Identification tax number                          
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--  
   +----------------------------------------------------------------------------+
   3.                                                 
      Information about source of income                                       
                                                                               
                     ------------------------------   <**> --T-
         Type of income                                     Number <**>   
                              L------------------------------             L-+--
   +----------------------------------------------------------------------------+
                                                                               
                  -  --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
         Contractor                               
                                    L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                            Name    --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                            in full                      
                                    L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                               ------------------------------------
                            Full address                                     
                                                                             
                                          L------------------------------------
                                         --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                            Identification                   
                            tax number      L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                        -----------------------  --T-T-T-T-T-
         Contract            Number                        Date       
                                    L-----------------------      L-+-+-+-+-+--
   +------------------------------------------------------------T---------------+
             --T-T-T-T-T-T-T-T-T-T-T-                       
    <***>           A                                    
   Total income in whole      L-+-+-+-+-+-+-+-+-+-+-+--           <*>
   currency units <***>                                           Currency    
   +------------------------------------------------------------+    code <*>   
    ,                                         --T-T-    
           --T-T-T-T-T-T-T-T-T-T-T-                   
                      B                         L-+-+--    
   Amount of tax to be        L-+-+-+-+-+-+-+-+-+-+-+--                       
   withheld at basic rate                                                     
   +------------------------------------------------------------+---------------+
    ,    --T-T-T-T-T-T-T-T-T-T-T-       --T-
       C                     Tax Rate     
   Tax under the Treaty       L-+-+-+-+-+-+-+-+-+-+-+--                   L-+--
   +-------------------------------------------------------T---------------------
     ,               --T-T-T-T-T-T-T-T-T-
   (. B - . C)                                                
   Total tax not subject to withholding                   L-+-+-+-+-+-+-+-+-+--
   (line B - line C)                                      
   L--------------------------------------------------------

     _____   Enclosures on _____ pages

       --------------------------------
       <*>   "BIG directory".  By  reference  book  "BIG
   directory".
       <**>             . 2.
   Order number in the List of the types of income on page 2.
       <***>         .   Can   be
   specified an approximate ammount.

   ----------------
     XX X X
   L--L--L--L--L--L--L--L--
     Form 1013DT (1997)                           . Page 2
   ___________________________________________________________________----------
      , :                                                            
      I declare that                                                           
      -                      
         ;                                                  
        the above  mentioned income is not connected with activities           
        carried in the Russian Federation                                      
      -                          
        ;                                                               
        the recipient  of  the  above income is being the beneficial           
        owner                                                                  
                                                                               
          .                  
      I hereby  confirm  that  the  information provided herewith is           
   accurate                                                                    
     -----------------        -----------------------------------   
                                                          Occupation 
                       Stamp L-----------------------------------            
                             -----------------------------------         
                                                                    Name   
                             L-----------------------------------            
     L-----------------        -----------------------------------     
                                                                   Signature 
                               L-----------------------------------            
                               --T-T-T-T-T-                               
                                          Date                          
                               L-+-+-+-+-+--                                   
   +----------------------------------------------------------------------------+
   4.          
      Note of the foreign Tax authority                                        
   +----------------------------------------------------------------------------+
      ,          
                                                              
      It is hereby confirmed that the claimant is a resident of _______________
   ____________________________________________________________________________
                        / name of the country                    
                  /
                                                          
      in the sense implied in the Double Taxation Convention between the USSR /
      Russian Federation and                                                   
   ____________________________________________________________________________
                        / name of the country                    
                                                                               
             ----                                     
          The claimed incomes are           
          taxable                    L----      ( ----)
     -----------------    ---- in the country                 X  
                       not taxable     of residence            (mark L----)
                                   L----                                     
                                                                             
                       ---------------------------------    
                       Stamp                                     
     L-----------------        L---------------------------------Date and Place
                               ---------------------------------       


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