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1 NEOPHODNA DOKUMENTACIJA ZA OTVARANJE RAČUNA STRANOG PRAVNOG LICA / NECESSARY DOCUMENTS FOR ACCOUNT OPENING OF NON-RESIDENT LEGAL ENTITIES OF-PL-P-018 ver Dokumentacija koju dostavlja Klijent Documents submitted by the Client Zahtev za otvaranje računa potpisan od strane zakonskog zastupnika, ovlašćenog lica iz Rešenja o upisu centrale u sudski registar (Banka dostavlja obrazac). Application for Account opening signed by authorized person listed in the extract from the Register of Companies (form provided by the Bank) Karton deponovanih potpisa lica ovlašćenih za raspolaganje sredstvima na nerezidentnom računu (Banka dostavlja obrazac) List of specimen signatures of persons authorized to manage the funds on the non-resident accounts (form provided by the Bank) Rešenje ili Izvod iz registra u kome je nerezident upisan u državi u kojoj ima registrovano sedište (ili, ako je osnovan u državi u kojoj se ne vrši upis u takav registar, drugi odgovarajući dokument o osnivanju na osnovu koga se može utvrditi pravni oblik ovog nerezidenta i datum njegovog osnivanja), koji ne sme biti stariji od 3 meseca, overeno u skladu sa pravilima međunarodne overe*, sa prevodom na srpski jezik koji treba da je overen pečatom i potpisom sudskog tumača Republike Srbije** Decision on Registration issued by the relevant institution or Extract from the Register of Companies in which the non-resident is entered in the country of its registered head office (or, if it is incorporated in a country in which such entry into register is not done, another appropriate document of incorporation on the basis of which it is possible to determine the legal form of such non-resident and the date of its incorporation) which must not be older than three months, verified/certified in accordance with the rules of international certification*, translated into Serbian language and verified by certified court interpreter of Republic of Serbia** Izvod iz zakona, odnosno drugog propisa ako se nerezidentni račun otvara po tom osnovu Extract from the law and/or another regulation if a non-resident account is opened on that basis Dokument nadležnog organa koji sadrži poreski identifikacioni broj nerezidenta pravnog lica, koji ne sme biti stariji od tri meseca, ako je taj nerezident poreski obveznik Republike Srbije i ako se zahtev odnosi na otvaranje dinarskog računa nerezidenta. Document of a competent body containing the tax identification number of the non-resident legal entity which must not be older than three months, if such non-resident is a taxpayer of the Republic of Serbiaand for opening RSD non-resident account Potpis zastupnika iz rešenja o registraciji nerezidenta pravnog lica u državi sedišta, odnosno potpis drugog lica koje je ovlašćeno za podnošenje zahteva za otvaranje računa nerezidenta, overen kod nadležnog organa. Signature of the representative designated in the decision on registration of the non-resident legal entity in the country of its head office and/or signature of another person authorized to submit the request for the opening account,, certified by competent body. Statut društva ili akt o osnivanju sa prevodom na srpski ili engleski jezik Statute of the Company or Articles of Incorporation, translated into Serbian or English language Punomoćje centrale za otvaranje računa i obavljanje transakcija koje ne sme biti starije od 3 meseca, ukoliko lice koje otvara račun nije ovlašćeno u sudskom registru, overeno u skladu sa pravilima međunarodne overe*, sa prevodom na srpski jezik koji je overen pečatom i potpisom sudskog tumača Republike Srbije Authorization of the Headquarters for opening the account and effecting the account transactions, which must not be older than three months, in case the account is opened by a person who is not authorized in the Court Registry, certified in accordance with the rules of international certification*, translated into Serbian language and verified by certified court interpreter of Republic of Serbia Forma dokumenta Document form ili fotokopiju overenu u skladu sa pravilima međunarodne overe* ne starije od 3 meseca / Copy certified in accordance with the rules of international certification*, which must not be older than 3 months for per usal Fotokopija i original prevoda overen pečatom i potpisom ovlašćenog sudskog tumača Photocopy ili fotokopija koju je overio nadležni organ uz original na uvid, ne starije od 3 meseca or photocopy certified by competent body and for per usal ili overena kopija Fotokopija Photocopy ili fotokopija overena u skladu sa pravilima međunarodne overe*, ne starije od 3 meseca or Copy certified in accordance with the rules of international certification*, which must not be older than 3 months Dokaz o identitetu fizičkih lica važeća isprava sa fotografijom (pasoš, lična karta i dr.) izdata od strane nadležnog državnog organa za: 1. Fotokopija uz strana 1 od 4

2 Proof of the identity of individuals a valid document with a photograph (passport, ID card, etc.) issued by competent state bodies for: 1. Ovlašćeno lice za zastupanje koje uspostavlja poslovni odnos Person authorized for representation which established business relationship 2. Punomoćnika ili prokuristu koji u ime i za računu pravnog lica uspostavlja poslovni odnos uz obavezu dostavljanja fotokopije isprave za ovlašćeno lice za zastupanje davaoca ovlašćenja The proxy or procurator who in the name and on behalf of legal entity established the business relationship with an obligation to submit a copy of the document for the person authorized for representation provider of the authorisation 3. Lica ovlašćena za raspolaganje sredstvima sa računa (lica navedena na Kartonu deponovanih potpisa) Persons authorized to dispose of the funds on the account (persons listed on the Specimen Signature card original na uvid Photocopy with original for inspection 2. Fotokopija uz original na uvid Photocopy with original for inspection 3. Fotokopija Photocopy Dokumentaciju sa prevodom na srpski ili engleski jezik, ne stariju od 3 meseca, iz koje se može utvrditi vlasnička struktura preduzeća, do fizičkih lica vlasnika najmanje 25% vlasničkih i upravljačkih prava -Documentation translated into Serbian or English language, not older than three months, from which can be determined holder of at least 25% of business participation, shares, or other rights on basis of which he/she participates in management of legal entity. -Popunjen obrazac Vlasnička struktura (Banka dostavlja obrazac) -Ownership structure form (form provided by the Bank) Ako je osnivač stranog pravnog lica drugo strano pravno lice: If the founder of foreign legal entity is other foreign legal entity: - Izvod iz registra u kom je registrovano pravno lice osnivač koje ne sme biti starije od 3 meseca, overen od strane suda ili javnog beležnika notara, u skladu sa pravilima međunarodne overe Excerpt from the registry in which the founding legal entity is registered, which must not be older than 3 months, validated by court or public notary, within the regulations of international validation - Ukoliko se u izvodu iz registra nekog stranog pravnog lica u vlasničkom lancu ne vidi ko je njegov direktan vlasnik: izvod iz registra i dokument u kojem se vidi taj podatak, sve do krajnjih vlasnika fizičkih lica, koja imaju direktno ili indirektno (preko drugog pravnog lica) najmanje 25% vlasničkog udela. If it is not certified who is the direct owner in the excerpt from the registry for some nonresident legal entity: Excerpt from the registry and the document which contains that information until the final owners physical persons, which has direct or indirect (via other legal entity) ownership of at least 25%. - izvod treba da je preveden na srpski jezik i overen pečatom i potpisom od strane sudskog tumača. Excerpt has to be translated to Serbian and verified by stamp and signature of court interpreter. Ako je osnivač stranog pravnog lica domaće pravno lice koje ima najmanje 25% vlasničkog udela ili akcija: If the founder of foreign legal entity is domestic legal entity, which has at least 25% of ownership or shares - izvod iz registra i/ili dokument u kojem se vidi taj podatak, sve do krajnjih vlasnika fizičkih lica, koja imaju direktno ili indirektno (preko drugog pravnog lica) najmanje 25% vlasničkog udela. Excerpt from the registry and/or document which contains that data, until the final owners physical persons, which has direct or indirect (via other legal entity) ownership of at least 25%. Ugovor o otvaranju i vođenju nerezidentnog računa Contract on Opening and Keeping of non-resident Account Fotokopija uz original dokumentacije na uvid, ne starije od 3 meseca, obrazac i fotokopije pasoša Photocopy and for per usal of the documentation, which must not be older than 3 months, original form and passort photocopies *Pravila međunarodne overe: Legalizacijom dokumenata potvrđuje se verodostojnost potpisa potpisnika isprave. Postoje tri stepena legalizacije: 1. Ako država iz koje potiče dokumentacija ima potpisan bilateralni ugovor sa Republikom Srbijom dovoljno je da dokumentacija sadrži službeni potpis ovlašćenog lica te države (javnog beležnika, državnog organa i sl.). To znači da u ovom slučaju nije potrebna overa Apostilom. 2. Ako država iz koje potiče dokumentacija nema potpisan bilateralni ugovor sa Republikom Srbijom a nalazi se na spisku zemalja potpisnica Haške konvencije potrebno je da dokumentacija, pored službenog pečata i potpisa ovlašćenog lica te države, bude snadbevena i pečatom Apostila. To znači da je u ovom slučaju potrebna overa Apostilom. strana 2 od 4 Paraf

3 3. Ako država iz koje potiče javna isprava nema sa Republikom Srbijom zaključen ni bilateralni ugovor niti je ta država potpisnica Haške konvencije u tom slučaju je neophodna puna legalizacija javne isprave. To znači da je neophodno da javna isprava bude overena od strane nadležnih organa te države na način utvrđen zakonom te države. U svakom slučaju potrebno je da javna isprava bude overena od Ministarstva spoljnih poslova te države i od strane Diplomatsko konzulatnog predstavništva Republike Srbije u toj zemlji odnosno Minnistarstva spoljnih poslova Republike Srbije. *Rules of international certification: Legalization of documents confirm the authenticity of the signature of the signatory of the document and authenticity of the stamp placed on the document. There are three degrees of legalization: 1. If the State of origin of the documentation has signed a bilateral agreement with the Republic of Serbia, it is sufficient that the documentation contains the official signature of the authorized person and the state (public notary, state body etc.). This means that in this case is not required certification by Apostille. 2. If the State of origin of the documentation has not signed a bilateral agreement with the Republic of Serbia and it is on the list of countries signatory to the Hague Convention, it is required that documentation, besides the official stamp and signature of the authorized person of that State, contains the stamp of Apostille. This means that in this case, the Apostille certificationis required. 3. If the State of origin of the a public document does not have concluded a bilateral agreement with the Republic of Serbia, nor this country is a signatory to the Hague Convention in this case is necessary full legalization of public documents. This means that it is necessary that public documents be certified by the competent authority of that State in the manner prescribed by the law of that State. In any case it is necessary that a public document is certified by the Ministry of Foreign Affairs of that country and by the diplomatic missions of the Republic of Serbia in that country respectively by Ministry of Foreign Affairs of the Republic of Serbia. ** Nerezident dostavlja ovaj dokument najmanje jednom godišnje. Ako nerezident navedeni dokument ne dostavi u roku od godinu dana od dana njegovog poslednjeg dostavljanja banka neće izvršavati transakcije tog nerezidenta do dostavljanja tog dokumenta ** Non-resident shall submit this document at least once a year. If the non-resident fails to submit the above document within the year from its latest submission, the bank shall not perform the transactions of such non-resident until the submission of such document. Ugovor o otvaranju i vođenju nerezidentnog računa na osnovu dostavljene dokumentacije priprema Banka, u najkraćem mogućem roku. Contract on Opening and Keeping of non-resident Account, on the basis of submitted documentation is prepared by the Bank, in the shortest period possible. Banka će kao validna dokumenta prihvatiti samo kopije overene u skladu sa pravilima međunarodne overe sa datumom ne starijim od tri meseca. As a valid documentation, the Bank shall accept only copies certified in accordance with the rules of international certification* with the date not older than three months. Ukoliko imate registrovano predstavništvo vaše firme u Srbiji i želite da predstavništvo raspolaže sa sredstvima na računu vaše firme, neophodno je da date ovlašćenje za raspolaganje sredstvima na vašem računu kod OTP banke Srbija a.d. Novi Sad, ne starije od tri meseca, overeno u skladu sa pravilima međunarodne overe* sa prevodom na srpski jezik koji je overen pečatom i potpisom sudskog tumača Republike Srbije, i dostavite, pored gore navedene dokumentacije, i sledeće: In case you have a registered representative office of your Company in Serbia and you would like the representative office to dispose with funds on the account of your Company, it is necessary to give the authorization for disposal of funds on the account, not older than three months, certified in accordance with the rules of international certification*, translated into Serbian language and verified by certified court interpreter of Republic of Serbia, and along with the aforementioned documentation also submit the following: 1. Rešenje o registraciji izdato od strane Agencije za privredne registre Decision on Registration issued by the Business Register Agency Fotokopija uz original/overenu fotokopiju na uvid Photocopy and /verified Copy for per usal Potvrda o poreskom identifikacionom broju PIB (osim za klijente koji su registrovani u Agenciji za privredne registre Republike Srbije ) Certificate of tax identification number (except for clients registered in the Serbian Business Registers Agency). Overeni potpisi lica ovlašćenih za zastupanje (OP obrazac) Verified signatures of persons authorized for representation (OP forms) Lista ovlašćenih potpisnika za raspolaganje sredstvima na računima, potpisana od strane zakonskog zastupnika predstavništva, i potpisana od strane zakonskog zastupnika stranog pravnog lica iz Rešenja o upisu centrale u sudski registar (Banka dostavlja obrazac) List of signatures of persons authorized to manage the funds on the non-resident accounts, signed by authorized person of representative office,, and signed by authorized person listed in the extract from the Register of Companies of Headquarters, e (form provided by the Bank) Fotokopije ličnih dokumenata zakonskog zastupnika i svih lica ovlašćenih za raspolaganje sredstvima na računima Passport photocopies of authorized person listed in the extract from the Register FotokopijaPhotocopy ili overena fotokopija or verified Copy Fotokopija Photocopy OF-PL-P-018 Neophodna dokumentacija za otvaranje deviznog tekućeg računa za pravna lica Strana 3 od 4

4 of Companies and all persons authorized to manage funds on the Account U nadi da ćemo uspešno poslovno sarađivati, Hoping to have successful business cooperation, OTP BANKA SRBIJA A.D. NOVI SAD Vaša OTP banka Srbija Verujemo jedni drugima Info centar: strana 4 od 4

5 Zahtev za otvaranje nerezidentnog računa Request for opening a new non-resident current account ZA-PL-P-022 ver Please open for us accounts with OTP Banka Srbija a.d. Novi Sad: Molimo vas da nam kod OTP banke Srbija a.d. Novi Sad otvorite račun: Current account (Tekući račun) Deposit account (Depozitni račun) in the following currencies: za sledeće valute: RSD EUR USD GBP CHF CAD NAME OF THE COMPANY (Naziv klijenta) MAILING ADDRESS (Adresa za dostavu pošte u Republici Srbiji) Attention (Na ruke) Street (Ulica) City (Grad) Country (Država) TELEPHONE (Kontakt telefon) FOR RECEIVING ACCOUNT STATEMENTS ( za primanje izvoda po računu) Contact person (Kontakt osoba) P.O.Box Postal code (Poštanski broj) FAX number (Broj faksa) TAX IDENTIFICATION NUMBER Poreski identifikacioni broj (PIB) Company registration number (Broj registarskog uloška) Date of incorporation (Datum upisa) Address of Registrated Office (Adresa sedišta pravnog lica) STATUTORY INFORMATION (PODACI O REGISTRACIJI) Type of activity (Vrsta delatnosti) Company is a taxpayer of the Republic of Serbia (Client has a permanent Business Unit in the Republic of Serbia, or client has a tax representative in the Republic of Serbia) (Klijent je poreski obveznik Republike Srbije (Klijent ima stalnu poslovnu jedinicu u Republici Srbiji, Ili je odredio poreskog punomoćnika u Republici Srbiji)) Yes (Da) No (Ne) AUTHORISED PERSON FOR REPRESENTING (OVLAŠĆENO LICE ZA ZASTUPANJE) First and last name, address, place and date of birth, number, date and place of issuance of identification document, personal number (Ime i prezime, adresa, mesto i datum rođenja, broj datum i mesto izdavanja identifikacionog dokumenta, JMBG) strana 1 od 2

6 Hereby we authorize you to debit our account with you for commissions according to the Decision on tariff as to products and services of OTP banka Srbija a.d. Novi Sad (Ovim Vas ovlašćujemo da u naše ime i za naš račun možete izvršiti naplatu troškova i provizije u skladu sa važećom Odlukom o utvrđivanju tarifnika kamatnih stopa naknada i provizija OTP banke Srbija a.d. Novi Sad) You are authorised to accept and execute our orders sent by fax or . (Saglasni smo da naše naloge dostavljene faksom ili putem -a izvršavate kao originale) In accordance with any facsimile or instructions implying to be from us, authenticated with the Specimen Signature Card which is in your possession in usage order, we agree to: keep you from indemnities against all actions, proceedings, liabilities, claims, damages, costs, losses and expenses in relation to your actions on such instructions irrevocably authorize you to debit our account immediately for all sums paid by the Bank in respect to such instructions and to debit our account for all sums of money whatsoever, interests, charges and expenses which may incur as a result of Bank s compliance with such facsimile instructions. (Prilikom izvršenja naših naloga poslatih faksom ili putem -a i potpisanih od strane ovlašćenih osoba čiji su potpisi u skladu sa potpisima na depo kartonu oslobađamo vas odgovornosti za sve postupke, reklamacije, štete, gubitke i troškove nastale usled postupanja po pomenutim nalozima ovlašćujemo vas da izvršite zaduženje našeg računa za sve troškove koji nastanu izvršenjem pomenutih naloga kao i za sve novčane izdatke, kamate i rashode koje banka može snositi postupajući u skladu sa instrukcijama na nalozima) USE OF STAMP IN BUSINESS WITH THE BANK (KORIŠĆENJE PEČATA U POSLOVANJU SA BANKOM) YES (DA) NO (NE) The Client who declares to use the stamp, is obliged to deposit it on the Signature Specimen Card and to stamp payment orders/bill of exchanges/ direct debit authorizations and other documents submitted to the Bank in connection with the opening and maintaining this account and explicitly requiers from the Bank to refuse each document in connection with opening and maintaining this account that is not stamped. (Klijent koji se opredeli da koristi pečat u obavezi je da deponuje pečat na Kartonu deponovanih potpisa i overava pečatom platne naloge, menice, saglasnosti direktnog zaduženja i drugu dokumentaciju koju dostavlja Banci u vezi sa otvaranjem i vođenjem ovog računa i izričito zahteva od Banke da odbije svaki dokument u vezi sa otvaranjem i vođenjem ovog računa koji nije overen pečatom.) The Client who declares not to use the stamp does not deposit it on the Signature Specimen Card, and does not stamp payment orders/bill of exchanges/ direct debit authorizations and other documents submitted to the Bank in connection with the opening and maintaining this account. (Klijent koji se opredeli da ne koristi pečat - ne deponuje pečat na Kartonu deponovanih potpisa niti overava pečatom platne naloge, menice, saglasnosti direktnog zaduženja i drugu dokumentaciju koju dostavlja Banci u vezi sa otvaranjem i vođenjem ovog računa.) Date (Datum) Sign and signiture (Pečat i potpis) Izveštaj zaposlenog zaduženog za otvaranje računa Na osnovu zahteva za otvaranje računa i podnesenih naloga, zaposleni zadužen za otvaranje računa utvrdio je da podnosilac zahteva ispunjava / ne ispunjava uslove za otvaranje računa. (datum) Potpis ovlašćenog lica Banke Verifikovao Vaša OTP banka Srbija Verujemo jedni drugima strana 2 od 2 Info centar:

7 Specimen signatures for non-resident account Каrton deponovanih potpisa za nerezidentni račun OF-PL-P-014 ver NUMBER OF NON-RESIDENT ACCOUNT: Broj nerezidentnog računa: PHONE/FAX/ Telefon/Faks/ ADDRESS: Adresa: CLIENT S NAME: Naziv klijenta: COUNTRY AND CITY: Država i grad: BANK CERTIFICATION DATE: Datum kada je banka overila karton deponovanih potpisa: WHICH GIVES AUTHORITY TO FOLLOWING PERSONS FOR DISPOSAL OF FUNDS ON THE NON-RESIDENT ACCOUNT: kojim se ovlašćuju sledeća lica za raspolaganje sredstvima na nerezidentnom računu NAME AND SURNAME Ime i prezime SIGNATURE Potpis COUNTRY, CITY Država, Grad PASSPORT NUMBER Broj pasoša VALIDITY OF PASSPORT Rok važenja pasoša TYPE OF SIGNATURE Vrsta potpisa 1. autonomous - samostalno 2. collective - kolektivno 3. limited - ograničeno 4. unlimited - neograničeno 1. autonomous - samostalno 2. collective - kolektivno 3. limited - ograničeno 4. unlimited - neograničeno 1. autonomous - samostalno 2. collective - kolektivno 3. limited - ograničeno 4. unlimited - neograničeno 1. autonomous - samostalno 2. collective - kolektivno 3. limited - ograničeno 4. unlimited - neograničeno THIS SPECIMEN SIGNATURE CARD IS VALID FROM THE BANK CERTIFICATION DATE UNTIL ITS WRITTEN RECALL Ovaj karton deponovanih potpisa važi od datuma potpisa i overe pečatom od strane Banke pa do pismenog opoziva *overa pečatom Klijenta nije obavezna ako Klijent sa Bankom nije izričito ugovorio upotrebu pečata/ The Stamp of the Client is not obliged if the Client with the Bank has not explicitly contracted the use of the stamp. AMOUNT OF THE FUNDS LIMIT Iznos ograničenja sredstava SIGNATURE OF THE PERSON AUTHORIZED FOR CLIENT REPRESENTATION Potpis lica ovlašćenog za zastupanje klijenta STAMP* OF THE CLIENT Pečat* klijenta STAMP AND SIGNATURE OF THE RESPONSIBLE PERSON OF THE BANK Pečat i potpis ovlašćenog lica banke Vaša OTP banka Verujemo jedni drugima Info centar:

8 IZJAVA ZASTUPNIKA/ PUNOMOĆNIKA O VLASNIČKOJ STRUKTURI KLIJENTA STATEMENT ON OWNERSHIP STRUCTURE OF-PL-P-036 ver U postupku otvaranja računa, pod punom materijalnom i krivičnom odgovornošću izjavljujem i dostavljam podatke navedene u donjoj tabeli za svako pravno i fizičko lice koje ima direktno ili indirektno (preko drugog pravnog lica) najmanje 25% poslovnog udela, akcija ili drugih prava na osnovu kojih ima ucešće u upravljanju ovog pravnog lica, odnosno ima ucešće u kapitalu pravnog lica sa najmanje 25% udela ili ima dominantan položaj prilikom upravljanja sredstvima ovog pravnog lica. In the process of account opening, under penalty of perjury, I hereby declare and submit information provided in the Table bellow for each legal entity and natural person with minimum 25% of direct or indirect (through other legal entity) business participation, shares or any other rights based on which such person/entity has participation in management of such legal entity, and/or participation in capital of the legal entity with minimum 25% participation or a dominant position in managing the funds of the legal entity. Pravno lice kome se otvara račun: MB Naziv Legal entity opening the account :: ID Name 1 Naziv pravnog lica osnivača: Name of legal entity owner: MB / ID: Sedište i adresa: Address: Udeo u %: Participation in %: R.b. Ime i prezime, Datum i mesto rođenja za FL/ Poslovno ime za PL First and last name, Date and place of birth for NP/Name of LE Prebivalište za FL/Sedište za PL Place of residence for NP/Address for LE Udeo u % Participation in % JMBG / MB PL ID No. Broj L.K. ili pasoša Passport No. 3 Dostavljena L.K./pasoš na uvid Banci Rezident/državljanin SAD US citizen/residency (zaokružiti) PIB iz SAD 2 US TIN FL- fizičko lice; PL pravno lice NP natural person; LE-Legal entity Izjavu dao zakoniti zastupnik/punomoćnik Statement given by a legal representative 1 NAPOMENA/NOTE: Obrazac se popunjava za svako pravno lice koje se pojavljuje kao osnivač pravnog lica koje otvara račun, kao i za svako drugo pravno lice u nizu koje se javlja kao osnivač tog pravnog lica osnivača. Ukoliko sva fizička lica imaju manje od 25% udela u vlasništvu navesti samo manjinski vlasnici. Ukoliko su vlasnici država i drugi državni organi navesti u državnom vlasništvu. The form is filled out for any legal entity that acts as the owner of legal entity opening an account, as well as for any other legal entity in sequence, which acts as the owner of that legal entity- owner. In case all natural persons have below 25% of shares in their ownership, indicate only "minority owners In case the State and/or other government authorities act as owners, indicate "state-owned 2 PIB iz SAD poreski identifikacioni broj za građane/državljane/pravna lica sa sedištem iz/u SAD US TIN Tax identification number for US citizens/residents 3 Banka ne zadržava kopiju dokumenta Bank does not retain a copy of the document. ime i prezime/first and last name JMBG/za strano fizičko lice br.pasoša/ ID No./Passport No. Prebivalište i adresa/place of residence and address Broj L.K. ili Pasoša/ID card No./Passport No. U/In Dana/Date

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