Value added tax return considered as annual return Closing down of business in 2014

For official use only Date of entry Accounted for Central Tax Office P.O. Box 1004 L - 1010 Luxembourg Tel.: (+352) 44 905-1 IBAN LU31 1111 0114 1970 0000 BIC Code: CCPLLULL Value added tax return considered as annual return Closing down of business in 2014 A (Law of 12.2.1979 as subsequently modified) Statutory deadline for filing the return and payment of tax: on page 4 (Name and first name, or corporate name) (Street and house number) (Country code, post code and city) I. ASSESSMENT OF TAXABLE TURNOVER A. Overall turnover 1. VAT accounting scheme: on sales 204 on payments received 205 (tick as appropriate) 2. Total Sales / Receipts (taxed, exempt and out of national scope transactions, according to business branch) Amounts VAT excluded (1) (a) Supply of inhouse manufactured goods 001 (b) Supply of goods not manufactured inhouse 002 + (c) Net profit margin (special arrangement: Art. 56ter) 003 + (2) Supply of services 004 + (3) Disposal of tangible and intangible capital assets when those transactions are ancillary transactions 005 + (4) 206 007 + 3. (1) Application of goods for private use or for that of the staff (Art. 13(a)) 008 + (2) Application for the purpose of business of goods produced in the course of the business (Art. 13(b)) 009 + (3) Use of goods considered business assets for purposes other than those of the business (Art. 16(a)) 010 + (4) Supply of services carried out free of charge for purposes other than those of the business (Art. 16(b)) 011 + 4. Total turnover 012 B. Exemptions and deductible amounts 5. (a) Intra-Community supply of goods to persons identified for VAT purposes in another Member State (MS) (Art. 43(1)(d), (e) and (f)) *) 013 (b) Intra-Community supply of new means of transport to persons not identified for VAT purposes who are established or reside in an other MS (Art. 43(1)(e)) 202 + 6. Exports (Art. 43(1)(a) et (b)) 014 + 7. Other exemptions (Art. 43 and 56sexies) 015 + 8. Other exemptions (Art. 44 and 56quater) 016 + 9. Manufactured tobacco 017 + 10. Transactions carried out (for which the place of supply is) abroad: (a) Supply, subsequent to intra-community acquisitions of goods, in the context of triangular transactions, when the customer identified for VAT purposes in the MS of destination of the goods is liable for payment of VAT in that MS *) 018 + (b) Supply of goods (other than new means of transport and products subject to exise duty), dispatched or transported by or on behalf of the supplier, carried out to customers not identified for VAT purposes and established or residing in the MS where the dispatch or transport ends, when these supplies are taxable in that MS (distance selling) 203 + (c) Supply of services, other than exempted from VAT in the customer's MS, to customers identified for VAT purposes in another MS, for which the customer is liable for VAT *) 423 + (d) Supply of services to customers identified for VAT purposes in another MS, exempt in the customer's MS 424 + (e) Other supplies carried out (for which the place of supply is) abroad 019 + 11. Inland transactions for which the customer is liable for the payment of VAT: 419 + 12. Total to deduct (under point C) 021 C. Taxable turnover (net of VAT) : point 4 (total turnover) minus point 12 (012-021) 022

- 2 - II. ASSESSMENT OF VAT DUE (output tax) Taxable amount (net of VAT) Tax 13. Breakdown of taxable turnover: rate of 15 029 038 6 030 + 039 + 3 031 + 040 + 12 032 + 041 + 403 033 + 042 + 418 416 + 417 + 453 451 + 452 + 14. Intra-Community acquisitions of goods: rate of Total point 13: 037 046 - Intra-Community acquisition of goods (Art. 18(1)) - Application, for the purposes of business, of goods transferred from another MS (Art. 18bis) - Supply of goods, made within the territory in the context of triangular transactions and for which the declaring person is liable for payment of VAT 15 047 052 6 048 + 053 + 3 049 + 054 + 12 050 + 055 + exempt 194 + 15. Importation of goods rate of Total point 14: 051 056 (1) for business purposes 15 057 066 6 058 + 067 + 3 059 + 068 + 12 060 + 069 + exempt 195 + (2) for non-business purposes 15 061 + 071 + 6 062 + 072 + 3 063 + 073 + 12 064 + 074 + exempt 196 + Total point 15, (1) + (2): 065 407 16. Supply of services for which the customer is liable for the payment of VAT (1) provided to the declaring person by suppliers established or residing in another MS of the Community rate of 15 427 428 6 429 + 430 + 3 431 + 432 + 12 433 + 434 + Subtotal taxable amount point 16(1): 436 exempt 435 + (2) provided to the declaring person by suppliers not established or residing within the Community 15 437 + 438 + 6 439 + 440 + 3 441 + 442 + 12 443 + 444 + exempt 445 + Total point 16, (1) + (2): 422 219 (3) provided to the declaring person by suppliers established within the territory 15 420 421

- 3-17. Supply of goods for which the purchaser is liable for the payment of VAT rate of 6 222 223 Total taxable amount points 16 + 17 (=422+420+222) : 023 18. Special arrangements for tax suspension: adjustment (Art. 56sexies, (5) and (8)) 227 19. Total tax due (=046+056+407+219+421+223+227) (to be carried forward to point 31) 076 III. ASSESSMENT OF DEDUCTIBLE TAX (input tax) (a) Stock entries (b) Capital expenditures (c) Operational expenditures 20. VAT invoiced by other taxable persons for goods or services supplied 077 081 085 21. VAT due in respect of intra-community acquisitions of goods other than manufactured tobacco 078 + 082 + 086 + 22. VAT due or paid in respect of importations of goods other than manufactured tobacco and goods for non-business purposes 079 + 083 + 087 + 23. VAT due under the reverse charge (cf. points 16 and 17) 404 + 405 + 406 + Total (c) 088 Total (b) 084 + Total (a) 080 + 24. Tax due in respect of the application of goods for business purposes as referred to in Art. 13(b) (cf. point 3.2) 090 + 25. Tax paid as joint and several guarantee in accordance with the conditions laid down in Art. 48 092 + 26. Adjusted tax - special arrangements for tax suspension (Art. 56sexies(9), subpar. 2) 228 + 27. (1) Non recoverable input tax relating to supplies exempt pursuant to Art. 44 and 56quater 094 - (2) Non recoverable proportion of input tax determined in accordance with Art. 50 095 - (3) Non recoverable input tax in accordance with Art. 56ter(4) (when applying the margin scheme) 096 - Adjustment of deductions (a decrease of the recoverable input tax has to identified by a minus sign) 28. (1) in accordance with provisions of Art. 53 098 + (2) in accordance with provisions of the grand-ducal Regulation of 7 March 1980 - option to tax land 099 + 29. Other: 229 100 + 30. Total input tax deductible (to be carried forward to point 32) 102 IV. VAT to be paid or to be reclaimed 31. Total tax due (brought forward from point 19) 103 32. Total tax deductible (brought forward from point 30) 104-33. Exceeding amount: (a possible input tax surplus has to be identified by a minus sign) 105 A surplus of input tax shall be refunded by a transfer to the bank account the declaring person has indicated to the Administration.

- 4 - V. Additional information 34. Accounting period 233 / 234 / 2014-235 / 236 / 2014 Day Month Day Month 35. Phone number for contacting the declaring person: 237 36. Number of persons employed (average for the year): - with salary or wage 108 - with no salary (family members) 109 = 110 37. Taxable persons established in Luxemburg: place of storage of books, records and documents the keeping, drafting and issuing of which are required by the VAT law of 12 February 1979 and its implementing provisions, when this place of storage is outside of the territory of Luxemburg 238 38. Acquisitions, in the context of triangular transactions, made for a subsequent supply to a customer identified for VAT purposes in the MS of destination of the goods, and for which that customer has been designated as liable for the payment of VAT (Art. 18ter(2), subpar. 2) 152 Ad *) page 1: Amounts entered into lines 013, 018 or 423 match the sums of the corresponding sections of the recapitulative statements submitted for the 2014. The undersigned hereby certifies/certify that the information given in this return is true and complete., Date Signature(s) Statutory deadline for submission of this return and payment of tax: within 2 months following closing down of business in 2014. Submission of the return and payment of the tax have to be made to: Recette Centrale de l'enregistrement Account: P.O. Box 1004 IBAN LU31 1111 0114 1970 0000 L - 1010 Luxembourg BIC Code: CCPLLULL Profit and loss statement has to be attached when keeping adequate and orderly accounting records. The annexed forms are to be filled in accurately and filed jointly with the return.

- 5 - Registation nr. Appendix to the 2014 VAT return (A) Operational expenditures 1. Gross salaries 2) TOTAL if applicable VAT included BUSINESS PORTION VAT excluded of VAT invoiced 1) For official use only 1 2 3 4 5 239 240 114 of which productive salaries 241 242 243 2. Gross wages 2) 244 245 246 3. Occasional salaries 247 248 249 4. Compulsory social security contributions (employer's share) 250 251 252 5. Accident insurance 253 254 255 3) 6. Commissions 256 257 258 259 7. Staff travel and representation expenses 260 261 262 263 8. 264 265 266 267 268 4) 9. Accounting and bookkeeping fees (Indicate name and address of accountant on page 8 point (E) 269 270 271 272 10. 273 274 275 276 277 11. 278 279 280 281 282 12. Employer's travel and representation expenses 283 284 183 184 13. Electricity 285 286 287 288 14. Gas 289 290 291 292 15. Water 293 294 295 296 16. Heating 297 298 299 300 17. Telecommunications 301 302 303 304 18. Renting/leasing of 4) a) immovable property with application of VAT (Indicate name and address of lessor on page 8 point (E) 305 306 185 186 b) immovable property with no application of VAT 307 308 309 c) permanently installed equipment and machinery 310 311 312 313 19. Fire insurance 314 315 20. Property tax 316 317 21. 318 319 320 22. 321 322 323 23. Business tax 324 24. Licensing (cabaretage) tax and other taxes 325 25. Interest paid for long-term debts 326 26. Interest paid for short-term debts 327 27. Other financial costs 328 329 28. Stock and business equipment insurance 330 29. Public and professional third party liability insurance 331 30. Office expenses 332 333 31. Cleaning and maintenance of business premises 334 335 32. Fees and subscriptions paid to professional associations and learned societies 336 33. Papers and periodicals for business purposes 337 338 to be carried forward 339 340

- 6-3 4 5 34. Expenses for work carried out by third parties brought forward: 341 342 a) expenses for work carried out by sub-contractors 115 187 b) expenses for other work carried out by third parties 188 189 35. Shipping and transport expenses 343 344 36. Work clothes 345 346 37. Advertising and publicity 347 348 38. Packaging 349 350 39. Repair and maintenance of equipment and machinery 351 352 40. Other repairs 353 354 41. New acquisitions (tools and equipment) if their cost can be fully allocated to the year of acquisition or creation pursuant to Article 34 of Income Tax Law 355 356 42. 357 358 359 43. Total 'Appendix to Operational expenditures' (brought forward from page 9) 5) 361 362 44. Car expenses 190 191 45. Total Operational Expenditures 192 193 (B) Assessment of the taxable amount 6) for non-business use of assets allocated to business Art. 16(a) I. Motor vehicles Book (net asset) value 1.01.2014 363 Acquisitions in 2014 364 Sales in 2014 365 Depreciation for 2014 366 to be carried forward to point 5 below 7) Book (net asset) value at the time 367 of business closure TOTAL expenses VAT excluded VAT 1. Fuel (petrol, diesel) and lubricants 368 369 LPG 372 373 2. Repairs and servicing 374 375 3. Tyres, etc. 376 377 4. Leasing / renting 378 379 5. Depreciation 7) 380 6. Total: 382 Total kilometres travelled in 2014: 383 km Non-business portion: 384 km = 385 381 = 386 II. Other assets: 387 + 388 III. Total to be carried forward to point 3(3) of the annual return = 389 Comments: 1) Exclusively VAT actually invoiced; please do not show VAT due in respect of intra-community acquisitions of goods and importation of goods or VAT due under the reverse charge. 2) Not including payments on behalf of third parties (e.g. sickness benefits advanced on behalf of the national healthcare system - Caisse Nationale de Santé - and which will be reimbursed by the latter). 3) Including all special taxes (e.g. solidarity tax) charged on salaries and wages. 4) Deduction of VAT in respect of operating costs can be refused if the supplier's name is not or cannot be indicated. 5) A detailed list of expenses not listed under point (A) of the appendix to the annual return can be joined as 'Appendix to Operational expenditures'; total sums of such an 'Appendix' are to be carried forward to line 43 of point (A). 6) The taxable amount shall be the full cost of providing the services. 7) Only if the person declaring was or is able to reclaim VAT paid or declared in respect of the car's purchase.

- 7 - (C) Entry of stock for business purposes (all amounts VAT excluded) not falling within the scope of Art. 56ter 1) 1. Purchases of goods (within the territory of Luxembourg or abroad and subsequently brought to Luxembourg) which give rise to a chargeable event for the supplier or for the taxable person acquiring the goods (a) Purchases within the country 2) (b) Intra-Community acquisitions (c) Imports 3) 1.1. at the rate of 15 122 132 140 6 123 + 133 + 141 + 3 124 + 134 + 142 + 12 125 + 135 + 143 + 4) 4) 4 126 + 10 127 + 394 128 + 136 + 144 + exempt 197 + 198 + 199 + Subtotal: 129 137 145 5) + 146 1.2. Manufactured tobacco 130 + 138 5) + Total (c) 147 Total (b) 139 + Total (a) 131 + 2. Purchases of goods (within the territory of Luxembourg or abroad and subsequently brought to Luxembourg) which don't give rise to a chargeable event neither for the supplier nor for the taxable person acquiring the goods 150 + 148 3. Purchases of goods abroad which are not brought to Luxembourg 151 + 4. Total entry of stock 154 of which goods for resale 155 1) Does not pertain to goods categorised as capital or operational expenditures. 2) Including electricity, gas, heat and cooling energy supplied by a taxable person not established in Luxembourg, when the person declaring is liable for the payment of VAT under the reverse charge mechanism. 3) Including taxes, duties, levies and other charges, excluding VAT itself, as well as incidental expenses, such as commission, packing, transport and insurance costs, incurred up to the first place of destination within the country. The taxable amount shall also include any of the afore-mentioned incidental expenses resulting from transport to another place of destination within the Community, if that other place is known when the chargeable event occurs (Art. 34). 4) Agricultural products purchased from a taxable person applying the flat-rate scheme for farmers. 5) Price stated on the tax label less VAT included.

- 8 - (D) Stock / Miscellaneous (amounts VAT excluded) rate (1) Stock not falling within the scope of Art. 56ter and manufactured tobacco referred to in (D)(2) excluded Date of business closure 1.01.2014 395 /2014 15 156 169 6 157 + 170 + 3 158 + 171 + 12 159 + 172 + 4 160 + 173 + 10 161 + 174 + 396 162 + 175 + exempt 200 + 201 + Subtotal: (1) 163 176 of which - stock for resale: 164 177 - goods produced inhouse: 165 178 (2) Manufactured tobacco in stock (2) 167 + 180 + (3) Total (1) + (2) 168 181 (4) Work in progress (VAT excluded) 116 117 (5) Receivables from clients (VAT excluded) 118 119 (6) Payments made on account by clients (VAT excluded) 120 121 E) Names and addresses to be specified - points 9 and 18(a) of (A) (A)(9) Accountant: Name 397 Address 398 399 (A)(18)(a) Lessor: Name 400 Address 401 402 F) Annual accounts: submitted to the Trade and Companies Register (RCSL): Yes 998 No 999 (tick as appropriate)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) (29) (30) (31) (32) (33) (34) (35) (36) (37) (38) (39) (40) (41) (42) (43) (44) (45) (46) (47) (48) (49) (50) Appendix to Operational expenditures - 9 - Detail of expenses referred to in (A)(43) of the appendix to the annual return 411 VAT excluded 412 Business portion of VAT invoiced 1) 413 For official use only 3 4 5 Total to be carried forward to (A)(43) of the appendix to the annual return 414 415

Appendix to the 2014 VAT return Date of entry For official use only Accounted for Sequential nr. 501 Date of acquisition Acquisitions of depreciable/amortisable capital expenditures Acquisitions which cost cannot be fully allocated to the year of acquisition or creation pursuant to Article 34 of Income Tax Law Description Acquisition cost (when VAT included) 502 503 504 505 506 507 508 1 2 3 4 5 6 7 8 VAT Acquisition cost (VAT excluded) Subsidies received 1) Value to be depreciated/amortised 1) Column 6 minus column 7: to be carried forward to columns 4 and 7 of the depreciation table TOTAL: 509 510

Sequential nr. 501 Acquisitions of depreciable/amortisable capital expenditures Date of acquisition Description Acquisition cost (when VAT included) 502 503 504 505 506 507 508 1 2 3 4 5 6 7 8 VAT Acquisition cost (VAT excluded) Subsidies received 1) Value to be depreciated/amortised

2014 Depreciation/amortisation Table Sequential nr. 617 Date of acquisition Designation Value to be depreciated or amortised Deprec. or amort. Book (net asset) value at the beginning of 602 601 603 604 605 606 607 608 609 1 2 3 4 5 6 7 8 9 10 1) Acquisitions during 2) Sales during Depreciation or amortisation cost Book (net asset) value at the end of 1) For details, see table of acquisitions 2) VAT excluded 610 611 612 613 614 Non-business portion : 615 Business portion: 616

Depreciation/amortisation Table 617 Sequential nr. Date of acquisition Designation Value to be depreciated or amortised Deprec. or amort. Book (net asset) value at the beginning of 602 601 603 604 605 606 607 608 609 1 2 3 4 5 6 7 8 9 10 1) Acquisitions during 2) Sales during Depreciation or amortisation cost Book (net asset) value at the end of