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() " ". .

16.06.95 N 34

1 2008 ()

6
 
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    B7                                                          
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                                                        N 7
                                           
                                                      
                                                  
                                                      16.06.95 N 34

             
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                               199_ 

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                                                        N 8
                                           
                                                      
                                                  
                                                      16.06.95 N 34

   
   
   ()

                         
     ______________                   
   ___________________________                    ""
                                                "__" ________ 199_ .

                      
                   
                     
                    _______________  199_ .

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                                                        N 9
                                                          /Annex N 9/
                                           
                                     /to the Regulation of the State/
                                            
                                         /Tax Service of the Russian/
                                             16.06.95 N 34
                                          /Federation from    1995 N/

     ( .     31.12.1997 N -6-06/928)

   ---------------- ---------------------------------------------------
     XXXXXX                    
   L--L--L--L--L--L--L--L-- Fields are filled by block letters                
                            L---------------------------------------------------
    For the Claimant _______________________________________
       
      
   Double Taxation Convention
   between the Russian Federation and __________________________________________
   ----------------------T--------------------------------------------T---------
      1011DT(1997)                CLAIM                        
              for--
    Form 1011DT(1997)                               199 
   the State Tax Service       (  / )             L--
         of Russia       for a refund of tax withheld in Russia on           
                            income (except dividends / interest)             
   +------T--------------+--------T-------T---------------------------+---------+
           ""                    
         L------------------------                       
                                                                              
   +--------------------------------------+-------------------------------------+
   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-
                                             
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                              --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-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                              ------------------------------------------------
                                                                  
                              L------------------------------------------------
                               ------------------  <*>          --T-
    Full residential address                                              
                              CountryL------------------ Country code <*> 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 registration L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--  
   +----------------------------------------------------------------------------+
   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                                           
                Name in full        L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                                    --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
                                                         
                                    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-                     
                                                 
                   L-+-+-+-+-+-+-+-+-+-+-+--        <*> 
   Gross amount of income                     Currency code <*> 
   in whole currency units            --T-T-T-T-T-                     
                            Date of accrued               --T-T-      
                            of income       L-+-+-+-+-+--                 
   +-------------------------------------------------------+       L-+-+--      
          --T-T-T-T-T-T-T-T-T-T-T-                     
   Tax withheld                                                  
                                L-+-+-+-+-+-+-+-+-+-+-+--                     
   +-------------------------------------------------------+--------------------+
    ,      --T-T-T-T-T-T-T-T-T-T-T-     --T-
                             Tax Rate     
   Tax under the Treaty         L-+-+-+-+-+-+-+-+-+-+-+--                 L-+--
   +-------------------------------------------------T---------------------------
     ,               --T-T-T-T-T-T-T-T-T-
   Total amount to be reimbursed                                 
   L--------------------------------------------------   L-+-+-+-+-+-+-+-+-+--

     _____   Enclosures on _____ pages

       --------------------------------
       <*>      "BIC directory".  By reference book "BIC
   directory".
       <**>       ,  
     ,    .  Order number in the
   List  of the types of income,  named in the Claimant's copy of the
   Form.

   ----------------
     X   XX
   L--L--L--L--L--L--L--L--

    Form 1011DT(1997)                                    . Page 2
   ___________________________________________________________________----------
   4.     Bank of recipient                               
                              --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-
         Name in full                                 
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                              ------------------------------------------------
                                                                  
                              L------------------------------------------------
                               ------------------               --T-
    Full residential address                                              
                              CountryL------------------ Country code     L-+--
   +----------------------------------------------------------------------------+
                    --T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-
     Number of Bank account                           
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
      , :                                                            
      I declare that                                                           
      -            
        ;                                                             
      the above mentioned income is not connected with activities carried      
      in the Russian Federation                                                
      -   ,    3 ,            
                                         
      on the date of accrued entered in paragraph 3, above, recipient of the   
      above income has being the beneficial owner                              
                                                                               
          .                  
      I hereby confirm that the information provided herewith is accurate      
                                                                               
    ------------------        ------------------------------------  
                             L------------------------------------ Occupation
                                                                             
                       ------------------------------------        
                      Stamp  L------------------------------------     Name  
                                                                             
                             ------------------------------------    
    L------------------        L------------------------------------  Signature
                                                                               
                                --T-T-T-T-T-                              
                                L-+-+-+-+-+--  Date                            
   +----------------------------------------------------------------------------+
   5.          
      Note of the foreign Tax authority                                        
   +----------------------------------------------------------------------------+
      ,       __________ 
                                              
      It is hereby confirmed that the claimant during ________________________ 
      was 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           (mark  X )
                        not taxable   of residence                   L---- 
                                   L---                                      
                         ----------------------------       
                        Stamp                                    
                               L----------------------------  Date and Place 
                               ----------------------------          
                                                               Signature   
   L---------------------        L----------------------------                 
   L-----------------------------------------------------------------------------

   ------------------------------------------------
       List of types of income
   +--T-----------------T-------------------T---T--+--------------T-------------
   N            Type                     Type     
   L--+-----------------+-------------------+---+-----------------+--------------
   ---T-----------------T-------------------T---T-----------------T-------------
   01        Dividends          10   Interest from
   02           Income from              other paper  
            underwriting shares                          
                                  11   Interest from
   03         Income from              penalties    
        investment         12      Royalties    
       ..    funds etc.             ()              
   04       Interest from      13    Income from  
               corresponding         ()        leasings of  
     accounts                      movable      
                                              property     
   05       Interest from      14    Income from  
       credits               ()        leasings of  
   06       Interest from               real estate  
               deposits                                   
                                15   Premiums from
   07       Interest from              direct       
               corporate bonds           insurance and
                                                coinsurance  
                               16          Premiums from
   08       Interest from state     reinsurance  
               bonds              17    Interest on  
                                        depo of      
                               18      premiums     
   09       Interest (discount)                    Other income 
     ()     from notes                                          
                                                           
   L--+-----------------+-------------------+---+-----------------+--------------



   ---------------- ---------------------------------------------------
     X  XXX                    
   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---------
      1011DT(1997)                CLAIM                        
              for--
    Form 1011DT(1997)                               199 
   the State Tax Service       (  / )             L--
         of Russia       for a refund of tax withheld in Russia on           
                            income (except dividends / interest)             
   +------T--------------+--------T-------T---------------------------+---------+
           ""                    
         L------------------------                       
                                                                              
   +--------------------------------------+-------------------------------------+
   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-
                                             
                              L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
                              --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-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--
   +----------------------------------------------------------------------------+
                              ------------------------------------------------
                                                                  
                              L------------------------------------------------
                               ------------------  <*>          --T-
    Full residential address                                              
                              CountryL------------------ Country code <*> 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 registration L-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+--  
   +----------------------------------------------------------------------------+
   2.  ,                          


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