See instruction before filling, please. Corrective tax return SPECIMEN

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1 See instruction before filling, please. for / Specialized tax office Local branch in, for 0 Tax identification number C Z 0 Identification number 0 Tax return ) Proper tax return Part I Information about taxpayer 0 Name of the taxpayer Supplementary tax return Reasons for submitting of the supplementary tax return was find out on the day 0 Classification code for type of tax return Corrective tax return The taxable period pursuant to a letter ) of the Act d) Country code Serial number of the unit trust Number of attachments of Part II Number of special attachments ) Number of free attachments ) pursuant to subsection of the Act no. 0/00 Coll., Seal Number of unit trusts whose assets are managed CORPORATE INCOME TAX RETURN pursuant to the Act no. / Coll., as amended for the taxable period or the period for which the tax return is being filed. (hereinafter "Act") 0 Place of business 0 Bank connection from a) Street and orientation number, part of municipality and building number e) Telephone number f) Fax number 0 Tax return prepared and submitted by tax advisor ) yes no 0 Power of attorney for representation of tax adviser submitted to the tax office on the day ) 0 Legal obligation to have Financial Statements verified by an Auditor ) yes no Financial Statement or Summaries of Assets and Liabilities and of Income and Expenditure attached ) ) Transactions carried out with related persons ) b) Municipality c) Zipcode to yes no yes yes no no ) Main (predominant) activity Code of classification CZ-NACE ) The English version relates to the Czech version 0 MFin 0 model no. that is under the laws the only valid tax return form. 0/a MFin 0/a model no. (valid for the period started in 0, or its part which the deadline for filing tax returns expires after st December 0)

2 Part II Corporate income tax (hereinafter "tax") 0 ) The trading result (profit +, loss -) ) or the difference between income (revenues) and expenses ) to the day 0 ) 0 ) 0 0 ) ) ) 0 ) ) ) ) 0 0 ) Amounts which unjustifiably curtail income ( subsection letter a) point of the Act) and the value of non-monetary incomes ( subsection of this Act), if they are not included into the trading result or in the difference between income (revenues) and expenses on row 0 Amounts by which pursuant to subsection letter a) points to of this Act, increased the trading result (i.e. profit or loss) or the difference between income (revenues) and expenses on row 0 are increased Expenses (costs) not recognized as expenses (costs) incurred to generate, assure and maintain income ( or of the Act), if they are included into the trading result (i.e. profit or loss) or the difference between income (revenues) and expenses on row 0 Difference by which depreciation of tangible and intangible fixed assets ( and a of the Act) applied in the accountancy exceeds depreciation of these assets determined pursuant to to of the Act The alteration of the tax base pursuant to subsection of the Act in case of dissolving of the taxpayer with going into liquidation Subtotal (rows ) Incomes (revenues), that is not liable to tax according to subsection and of the Act, if they are included into the trading result or difference between income (revenues) and expenses (row 0) Incomes which at public beneficial taxpayers shall not be liable to tax pursuant to a subsection of this Act if they are involved into the trading result or in the difference between income (revenues) and expenses (row 0) Incomes that shall be tax-exempted pursuant to b if they are included into the trading result or in the difference between income (revenues) and expenses (row 0) Incomes that shall be tax-exempted pursuant to, if they are involved into the trading result or in the difference between income (revenues) and expenses (row 0) Amounts by which the trading result or the difference between income (revenues) and expenses may be reduced pursuant to subsection letter b) (row 0) Amounts by which the trading result or the difference between income (revenues) and expenses may be reduced pursuant to subsection letter c) of the Act Income not included into the tax base pursuant to subsection letter a) of the Act Incomes not included into the tax base pursuant to subsection letter b) of the Act Incomes and amounts not included into tax base pursuant to subsection of the Act with exception of income pursuant to subsection letter a) and b) of the Act Difference by which the depreciation of tangible fixed assets and intangible fixed assets computed pursuant to to of the Act exceeds depreciation of these assets claimed in accountancy Summary of each differences by which expenses (costs) incurred to generate, assure and maintain income exceed costs claimed in accountancy pursuant to subsection of the Act no. 0/00 Coll., ) Alteration of the tax base pursuant to subsection of the Act in case of dissolving of the taxpayer who is going into liquidation ) 0 Subtotal (rows )

3 Attachment no. of the Part II Identification no.; Tax identification number; C Z A. Allocation of expenses (costs) not being recognized as expenses (costs) incurred to generate, assure and maintain income filled in row 0, according to groups of accounts of account class Costs 0 Total pursuant to subsection of the Act no. 0/00 Coll., b) Accounting depreciation of tangible and intangible fixed asset claimed as expense (cost) incurred to generate, assure and maintain income pursuant to subsection letter v) of the Act Name of group of accounts (including the numerical indication) B. Depreciation of Tangible and Intangible fixed assets a) Tax depreciation of tangible and intangible fixed assets claimed as expenses (costs) incurred to generate, assure and maintain income pursuant to subsection letter a) of the Act 0 Depreciation of tangible and intangible fixed assets allocated into the category of depreciation Depreciation of tangible fixed assets allocated into the category of depreciation Depreciation of tangible fixed assets pursuant to 0 subsection of the Act as valid till December 00 Depreciation of tangible fixed assets pursuant to 0 subsection up to of the Act and 0 B of the Act Depreciation of intangible fixed assets pursuant to a of the Act, recorded in the property of the taxpayer in the taxable period that started in the year 00 and afterwards Accounting depreciation, with exemption pursuant to subsection letter zg) of the Act, of the tangible fixed assets that, are not determined for the purposes of the Act as the tangible fixed assets, and of the intangible fixed assets, that are not written off according to the Act, claimed pursuant to subsection letter v) of the Act as expense (cost) incurred to generate, assure and maintain income. For intangible fixed assets recorded into the assets of the taxpayer un till December 000 shall be applied the Act as valid to mentioned data, and on the time of withdrawal of the taxpayer s property. Depreciation of tangible and intangible fixed assets allocated into the category of depreciation Depreciation of tangible and intangible fixed assets allocated into the category of depreciation Depreciation of tangible fixed assets allocated into the category of depreciation Depreciation of tangible fixed assets allocated into the category of depreciation Total of tax depreciation of intangible and tangible fixed assets

4 C. Depreciation of receivables included into expenses (costs) incurred to generate, assure and maintain income and of statutory reserves (provisions) and statutory adjustments created pursuant to Act No. / Coll, on Reserves, as amended (hereinafter Act on Reserves ) for determining of Income Tax Base a) Depreciation of receivables included into tax expenses (costs) and statutory adjustments to receivables, with the exception of bank adjustments pursuant to of the Act on Reserves - all taxpayers filling b) Bank reserves and adjustments pursuant to of the Act on reserves - banks filling only ) Adjustments to receivables of debtors in insolvency proceeding created pursuant to of the Act of Reserves in the taxable period, for which the tax return is being filed Level of statutory adjustments to receivables of debtors in insolvency proceeding ( of the Act on Reserve) in the end of the period, for which the tax return is filed Level of not lapsed receivables with maturity after December, to that may be created statutory adjustments ( a of the Reserve Act) in the end of the period, for which the tax return is being filed Adjustments to not lapsed receivables created pursuant to a of the Act on Reserves in the period, for which the tax return is being filed Level of statutory adjustments to not lapsed receivables with maturity after December ( a of the Reserve Act) in the end of the period, for which the tax return is being filed Adjustments to receivables from guarantee for custom debt created pursuant to b of the Act on reserves in the period, for which the tax return is filed 0 Amount of statutory adjustments to not lapsed receivables that have been created pursuant to c of the Act on Reserves in the end of the period for which the tax return is being filed Total of receivables or acquisition costs of receivables acquired by assignment, claimed in the period of taxation, for which the tax return is being filed, as expense (cost) incurred to generate, assure and maintain of income pursuant to subsection letter y) of the Act Average level of balance value not lapsed receivables from credits pursuant to subsection letter a) of the Reserve Act Adjustments to not lapsed receivables from credits, pursuant to subsection letter a) Act on Reserves for the given taxable period Level of statutory adjustments to not lapsed receivables from credits ( subsection letter a) of the Act on Reserves) in the end of the taxable period Average level of provided bank s guarantees for credits pursuant to subsection letter b) of the Act on Reserves ) Reserves to provided bank s guarantees for credits, created pursuant to subsection letter b) of the Act on Reserves for the given taxable period Level of statutory reserves to provided bank s guarantee for credits ( a subsection letter b of the Act on Reserves) in the end of the taxable period c) Adjustments pursuant to of the Reserve Act - only saving and credit co-operatives and other financial institutions filling 0 ) Level of statutory adjustments to receivables from guarantee for custom debt ( b Act on Reserves) in the end of the taxable period, for which the tax return is being filed Adjustments to not lapsed receivables that have been created pursuant to c of the Act on Reserves in the given taxable period for which the tax return is being filed Average level of balance value of not lapsed receivables from credits provided to individuals on the base of the Credit Agreement, without accessory part, in assessment not reduced by adjustments just created ( a subsection of the Act on Reserves) for the given taxable period Level of the own equity on the last day of the taxable period ( a subsection of the Act on Reserves) pursuant to subsection of the Act no. 0/00 Coll., Adjustments to not lapsed receivables from credits provided to individuals on the base of Credit Agreement, created pursuant to a subsection of the Act on Reserves for the given taxable period Level of statutory adjustments to not lapsed receivables from credits provided to individuals on the base of Credit Agreement ( a subsection of the Act on Reserves) in the end of the taxable period

5 d) Reserves in insurance - only insurance filling Reserves in insurance created pursuant to of the Act on Reserves in the given period, for which the tax return is being filed Level of reserves in insurance ( of the Act on Reserves) in the end of period, for which the tax return is being filed e) Reserves for repairs of tangible assets - all taxpayers filling f) Other statutory reserves - only taxpayers holding authorization to its creation and usage filling ) D. Reserve for silvicultural operations created pursuant to of the Act on Reserves in the period, for which the tax return is being filed Level of reserves to silvicultural operation ( of the Act on Reserves) in the end of period, for which the tax return is filed Other reserves created pursuant to 0 of the Act on Reserves in the given taxable period E. Deduction of the tax loss from the tax base pursuant to subsection up to ) of the Act or the reduction of the tax base of a unit trust by negative difference between its income and expenses pursuant to 0 subsection of the Act, as valid until July 0 (fill in whole Czech crowns) The taxable period or the period Total amount The part of the tax loss in col. for which the tax return of tax loss recorded that have been that have been that may be is being filed, in which tax or assessed for the deducted in the deducted deducted in the loss arose period filled preceding taxable in the given following taxable from-to in the col. period taxable period period 0 Total F. Deduction pursuant to subsection of the Act a) Not filled b) Application of the deduction to support research and development from the tax base pursuant to subsection and a up to e of the Act (fill in whole Czech Crowns) The taxable period or the period for which the tax return is being filed, in which the claim on deduction arose, pursuant to subsection and a up to e of the Act, from to The part of claims on deduction from col. 0 Reserves to repairs of tangible assets created pursuant to of the Act on Reserves in the given taxable period Level of reserves to repairs of tangible assets ( of the Act on Reserves) in the end of the period of taxation The total amount of the claim on deduction to support research and development that has arisen in the period filled in the column That has been deducted in the preceding periods That has been deducted in the given period That may be deducted in the following periods pursuant to subsection of the Act no. 0/00 Coll., Total

6 c) Application of the deduction to support vocational education from the tax base pursuant to subsection and f up to h of the Act (fill in whole Crowns) The taxable period or the period for which the tax return is being The total amount of the claim on deduction The part of claims on deduction from col filed, in which the claim on to support vocational That has been That has been That may be deduction arose, pursuant to education that has arisen deducted in the deducted in the given deducted in the subsection and f up to h of the Act, from to in the period filled in the column preceding periods period following periods 0 Total G. Total value of gratuitous transactions which may be claimed, pursuant to 0 subsection of the Act, as a deduction from the tax base reduced pursuant to of the Act ) Total value of gratuitous transactions provided for the purposes laid down in 0 subsection of the Act for the deduction from the tax base reduced pursuant to of the act, including the amount from row From row the value of gratuitous transactions in the amount of the applied discounts on partial contribution from lotteries and other similar games H. Allocation of the total entitlement for tax reliefs ( subsection and a or b of the Act), that may be claimed on the r. 00 ) ) ) ) ) Relief pursuant to subsection letter a) of the Act Relief pursuant to subsection letter b) of the Act Total of relief pursuant to subsection of the Act (row + ) Relief pursuant to a ) or b ) of the Act I. Tax credit of the tax that have been paid in abroad ) Number of Separate Attachments Total of taxes paid in abroad, by which the tax liability may be reduced by the method of full tax credit Total amount of taxes paid in abroad to them may be claimed the method of simple (basic) credit (total of amounts from row of Separate Attachments to table I) Total amount of taxes paid in abroad, for which the tax liability may be reduced by the method of simple (basic) tax credit Separate Attachments (total of amounts from row of separate attachment of table I) Amount of taxes paid in abroad that may be credited by the method of full tax and simple (basic) tax credit ( the sum of row and ) Amount of taxes paid in abroad that cannot be credited (the positive difference between the amount on row and on r., increased by the positive difference between amounts on row and row 0 of the Part II) pursuant to subsection of the Act no. 0/00 Coll., J. Allocation of some items in the case of a limited partnership (fill in whole Czech crowns) and number of a row of the Part II, or number of row of marked table in attachment no. of the Part II, to that relates an the amount from the row or of this table 0 The tax base or the tax loss from row 00 (row 0) Total of rule out income (tax base and tax loss) liable to tax in abroad (row 0) Claim to deduction pursuant to subsection and f up to h of the Act (corresponding row of the column of the table F/c) Claim to deduction pursuant to subsection and a up to e of the Act (corresponding row of the column of the table F/b) The value of gratuitous transactions provided for the purposes laid down in 0 subsection of the Act (row of the table G) From the row the value of gratuitous transactions in the amount of the applied discounts on partial contribution from lotteries and other similar games Total entitlement for tax relief pursuant to subsection of the Act (row, table H) Total amount of tax paid in abroad, which can be credited by the method of full and simple (basic) tax credit (row, table I) The amount The amount pertaining The amount for the pertaining to general to limited partners limited partnership as partners the unit (column + )

7 K. Selected indices of economy 00 0 ) 0 Annual total amount of a net turnover Average number of employers converted, rounded to whole number Unit of measure CZK Persons Tax base before alteration by the part of the tax (tax loss) pertaining to general partners and by income liable to tax in abroad, to that exemption is claimed, and before reducing by items pursuant to and 0 subsection or subsection of the Act, or the tax loss before alteration by the part of the tax base (tax loss) pertaining to general partners and for the income liable to tax in abroad, to that exemption is claimed (row 0 + row 0 row 0) ) 0 Part of tax base or of the tax loss pertaining to general partners ) ) 0 0 ) ) ) Total of the exempted income (tax bases and tax losses) liable to tax in abroad ) ) Tax base after alteration by the part of the tax base (tax loss) pertaining to a general partners and by the income liable to tax in abroad, to that method of exemption is claimed, before reducing by items pursuant to and 0 subsection or subsection ) of the Act or the tax loss after alteration by the part pertaining to a general partner and by the income liable to tax in abroad to which the method of exemption is claimed (row 00 row 0 row 0) ) Deduction of the tax loss pursuant to subsection of the Act ) The deduction of unapplied claim arisen in the preceding taxable periods pursuant to subsection up to 0 and of the Act, as valid till the st December 00 Deduction of the claim on deduction to support research and development pursuant to subsection and a up to e of the Act, including deduction of unclaimed expenditures (costs) incurred during the implementation of research and development as amended by the Act effective to.. 0 Deduction of the claim on deduction to support vocational education pursuant to subsection and f up to h of the Act The tax base after the adjustment by the part of the tax base (tax loss) pertaining to general partners and by incomes liable to tax in abroad, to which the method of exemption is applied, reduced by items pursuant to, before reducing by items pursuant to 0 subsection or subsection of the Act ) (row 0 row 0 row 0 row row ) ) The amount pursuant to 0 subsection of the Act, by which public beneficial taxpayers ( a of the Act) may further reduce the tax base filled in row 0 Deduction of gratuitous transactions pursuant to 0 subsection of the Act (up to maximum 0 % of the amount in row 0) ) Tax base after alteration by a part of the tax base (tax loss) pertaining to general partners and by the income liable to tax in abroad, to that the method of exemption is applied, reduced by items pursuant to and items pursuant to 0 subsection or of the Act, rounded down to the whole thousand of Czech crowns ) (row 0 row row 0) The tax rate (in %) pursuant to subsection or subsection or subsection of the Act, in connection with subsection of the Act Tax (row 0 x row 0)/00 Tax reliefs pursuant to subsection and a or b of the Act (up to the amount on r. 0) ) Tax alterated by items entered on row 00 and row 0 (row 0 row 00 ± row 0) ) The credit of tax paid in abroad to the tax entered on row 0 ) (up to the amount entered on row 0) The tax after credit on row 0 (row 0 row 0), rounded up to whole Czech crowns ) Fill in pursuant to subsection of the Act no. 0/00 Coll., The separate tax base pursuant to 0b of the Act, rounded down to whole thousands ) Czech crowns Tax rate (in %) pursuant to subsection of the Act, in relation to subsection of the Act Tax from separate tax base rounded up to whole Czech crowns (row x row )/00 Credit of tax paid in abroad claimed to the tax of separate tax base (up to the amount filled in row ) The tax of separate tax base after tax credit (row row ), rounded up to the whole Czech crowns

8 0 Total tax (row 0 + row ) Last known tax for the purposes of determination of the amount and frequency of 0 the tax advances pursuant to a subsection of the Act (row 0 row = row 0) Part III Part IV Supplementary tax return Last known tax New ascertained tax (row 0, Part II) Increase (+), decrease ( ) of tax (row row ) Last known tax loss New established tax loss (row 0, Part II) Increase (+), decrease ( ) of tax loss (row row ) Part V Payment of the tax ) ) The total amount of tax advances ( a of the Act) paid The amount withheld by payer for purpose of tax securement ( e of the Act) Applied credit of tax collected by means of withholding tax ( subsection of the Act) Arrears (underpaid tax) ( ) (row + row + row row 0, Part II.)<0 Overpayment (+) (row + row + row row 0, Part II.)>0 Seal Autograph signature of the person authorized to signature pursuant to subsection of the Act no. 0/00 Coll., I DECLARE, THAT EVERY INFORMATION STATED BY ME IN THIS TAX RETURN IS TRUE AND COMPLETE AND I UNDERSIGN IT. INFORMATION ABOUT THE SIGNATORY. Name, surname, title/business company (name) of the legal entity Date of birth/registration number of tax consultant/id of the legal entity Code of the signatory Individual authorized to sign the tax return on behalf of the taxpayer (if the representative is a legal entity), with mention of the relationship to the legal entity (for example partner, authorized employee, etc.) Person authorized to signature Date Explanatory text: ) Delete as appropriate ) The tax office filling ) In case of made loss fill in the amount with minus sigh ) Only taxpayer filling, who is limited partnership ) If the taxpayer is limited partnership fill in only amounts pertaining to general partners ) While filing of the supplementary tax return pursuant to subsection or of the Act no. 0/00 Coll., Act, as amended, or pursuant to u of the Act, state the reasons for its filing in separate attachment. In electronic filing of these supplementary tax returns the text field for filing of parate attachment is included in the web application. ) Final Account or Assets and Liabilities Statement and Income and Expenditure Statement, as an enclosure marked under the item in part I., is part of the tax return subsection of the Act no. 0/00 Coll., as amended. The tax return for unit trusts submits the investment company that manages its property. For the purposes of electronic submission of the tax return, a Final Accounts is regarded as electronic attachment The Chosen Data from the Balance Sheet and The Chosen Data from Income Statement, eventually the Chosen Data from the Summary of Changes to Equity Capital that are part of software of application, and copy of attachment of Final Account, put in as an independent file. The Assets and Liabilities Statement and Expenditure Statement and Final Accounts, for which the electronic attachments with binding defined order statement are in software of application The Electronic version for tax administration not available, can be effectively declared via electronic attachments, which enable to paste a file as.doc,.txt,.xls,.rtf,.pdf or.jpg. ) If some of these items is filled, is necessity in sense of the partial instruction for its filling, specify on special enclosure subject content filled in the relevant row, eventually its calculation. Text items for fulfilling of separate attachment, in electronic submission of the electronic tax return, are parts of software of application. ) Calculation of the amount or other data entered on so marked row must be carried out in a separate annexe. Forms of the free attachments are issued by Ministry of Finance. For electronic filing of tax return is used electronic versions of the forms, that are parts of software of application Electronic filing for the Financial Administration. 0 ) Subsection of the Act