ACCESS APPLICATION. On 201 No. /Place of preparation/ Applicant:
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1 1 1 ACCESS APPLICATION Annex 2 to the Regulations of use of Inčukalns Underground Gas Storage Facility of the Joint-Stock Company Latvijas Gāze On 201 No. /Place of preparation/ Addressee: Applicant: Joint-Stock Company Latvijas Gāze (hereinafter referred to as the Storage Facility operator) Operational section Inčukalns Underground Gas Storage Facility. Post box 16, Ragana, Krimuldas parish, Krimuldas district, LV-2144, Latvia Registration No.: Legal address: On the basis of the information regarding free capacity published on the website of the Storage Facility operator, pursuant to the Regulations of Use of Inčukalns Underground Gas Storage Facility of the Joint-Stock Company Latvijas Gāze (hereinafter referred to as the Regulations) and the Standard contract, we, undersigned, hereby certify that (hereinafter referred to as the Applicant) would like to accumulate and storage of natural gas complying in terms of quality to Latvian National Standard LVS 459:2014 Combustible gases. Gas properties, parameters, quality assessment. in Inčukalns Underground Gas Storage Facility of the Joint-Stock Company Latvijas Gāze (hereinafter referred to as the Storage Facility) and delivery therefrom at the following volume and within the following time limits: 1 Supply of natural gas for accumulation is planned from within the following time limits and at the following volume: Item Month Nominated volume of accumulation m 3 1 April 2 May 3 June 4 July 5 August (20 C; Pa)
2 6 September 7 October 8 TOTAL 2 Delivery of natural gas from the Storage Facility is planned at the following volumes and within the following time limits by planning that after delivery from the Storage Facility natural gas shall be transported to.
3 2 2 Item Month Nominated volume of delivery m 3 (20 C; Pa) 1 October 2 November 3 December 4 January 5 February 6 March 7 April 8 TOTAL We hereby certify that, if our application will be accepted, the Applicant will conclude a contract regarding use of the Storage Facility services (hereinafter referred to as the Contract) within the time limit set by the Regulations and make payment for the use of the Storage Facility services within the time limit, according to the procedure and at the volume set by the Contract. We undertake to submit schedule of natural gas delivery volume by months coordinated with the natural gas transmission system operator of the Republic of Latvia to the Storage Facility operator before 1 October of each year indicating maximum and minimum daily volume of natural gas to be delivered. We agree that, taking into consideration maximum allowed capacities of the Storage Facility during the accumulation period and opinion of the transmission system operator of the Republic of Latvia regarding technical capacities of natural gas transmission, the Storage Facility operator shall be entitled to change our planned accumulation schedule and, taking into consideration maximum allowed capacities of the Storage Facility during the delivery period and opinion of the transmission system operator of the Republic of Latvia regarding technical capacities of natural gas transmission - to change our planned delivery schedule. Information on the Applicant s responsible person to be providing negotiations with the Storage Facility operator regarding all matters related to this access application, including conclusion of the contract:. (name, surname, position, contacts (phone, , fax)) Information on whether the Applicant can/can not be considered a company related to the Joint-Stock Company Latvijas Gāze within the meaning of the Law on Enterprise Income Tax
4 . Information on whether the Applicant is/is not registered in a state, with which the Republic of Latvia has concluded a Convention on the elimination of double taxation and tax evasion. Upon signing of this access application the Applicant certifies that the Storage Facility operator may assign to the Applicant the capacities of the Storage Facility services specified in this access application, to propose update of the capacities of the Storage Facility services specified in this access application and/or periods of use of the Storage Facility services, as well as to refuse access to the free capacity of the Storage Facility in cases specified in the Regulations. Annex 1: Current certification issued by the Lursoft database of companies on the Applicant or an extract from the Register of Enterprises of the state of residence of the Applicant or equal registers pursuant to the regulations of the state, where the Applicant was established;
5 3 3 2 A copy of decision adopted by the Register of Enterprises or a certification issued by the Register of Enterprises of the state of residence of the Applicant or equal registers confirming the representation rights of the executive institution of the Applicant or a procuration or corresponding authorization confirming the rights of the representative of the Applicant to submit the access application; 3 A certification issued by a tax authority of a competent state not earlier than 20 days prior to the day of submission of the access application confirming that the Applicant has no tax debts in Latvia and its state of residence, including debts of compulsory State social insurance contributions exceeding in total 150 euro in each state; 4 A certification issued by the Register of Enterprises of the Republic of Latvia or the Register of Enterprises of the state of residence of the Applicant or equal registers not earlier than 20 days prior to the day of submission of the access application confirming that no insolvency proceedings of the Applicant have been declared, no economic activity thereof has been suspended or discontinued, no legal proceedings have been initiated regarding the bankruptcy of the applicant, and it may not be determined that the applicant would be liquidated before the expiry of the foreseeable deadline of the execution of contract; 5 A copy of value added tax (hereinafter referred to as VAT) payer s certificate, certified according to the procedure provided by regulatory enactments. If the Applicant shall be registered as a VAT payer in several Member States of the European Union, a copy of registration certificate must be attached for the VAT payer s registration number, which the Applicant has planned to use for transactions related to the Storage Facility services. (Documents issued by institutions of the state of residence of an applicant, which is not registered by the Commercial Register of the Republic of Latvia, shall be submitted by the applicant accompanied by a translation into the official language certified according to the procedure provided by the Cabinet of Ministers or by notary public.) (Signature and position of the representative (-s) of the Applicant)
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