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Registration number3. Legal adddress and contacts Legal addressTel, faxE-mail84. Does Counterparty have mother or daughter companies? 1.Name (full)+Country of registration (for non-residents)1. Counterparty nameRegistration number 2.Name (full)p5. Does Counterparty make a part of corporation, holding group, industrial-financial group or other association?Name and surname Date of birthPosition in the company1. Name and surnameGrounds of influenceDirect ownershipIndirect ownership2. Name and surnameh8.1. Are there in Counterparty ownership structure physical persons being direct owners of 10% and more?3Df8.2. Are there in Counterparty ownership structure legal entities being direct owners of 10% and more?3A1. Name (full)2. Name (full)#Name and surname of public official(Period of mentioned position undertaking SignatureD Date of Questionnaire completion - _____ _____________ 20___ @. We confirm that personal data contained in the present Questionnaire are provided in line with consent of respective personal data subjects for data processing by the Company and submission of such information (data) with the aim of meeting requirements of Ukrainian legislation.)7. Counterparty final beneficial owners* Annex - Structure of ownership.ATTENTION! Annex is a sample only but not the form to fill in, may be provided in any suitable format. In case the present format is used, please delete all comments and links. The present sample is not universal and does not foresee all possible structure variations. The structure shall be verified by Counterparty signature and stamp (if available) fh-Scheme of Counterparty structure of ownership_Structure of ownership is provided to define all Counterparty final beneficiary owners (if any)4! Info field, to be deleted when filling in the form Counterparty FIRST LINELE (legal entity) 1 (name, % of ownership, country of registration for non-residents (if info available)9~LE 2 (name, % of ownership, country of registration for non-residents (if info available)*xPP (physical person) 1 (name and surname, % of ownership, country of permanent residence)6 1& n PP (indicate number of PP)STOP for physical personsLSTOP if there is no second line or if LE owns less than 10 % of Counterparty SECOND LINE@LE 3 (name, % of ownership)*@LE 4 (name, % of ownership)*:PP 2 (name, % of ownership)$Public float shares THIRD LINEX10 PP of 10% (indicate for each PP: name, % of ownership),:PP 3 (name, % of ownership)$; 1& n PP, each PP owns less than 10% (indicate number of PPs)#@LE 5 (name, % of ownership)*rFinal beneficiary owner (controller) - 1Indicate relevant info, delete the other variant!#Final beneficiary owners are absentATTENTION! Final beneficiary owners / fact of their absence is stated by the Counterparty solely. The Company checks correctness and completeness of information provided by Counterparty based on submitted structure of ownership. Attention! Ownership by one person solely or together with associated physical and/or legal persons of a part of 25% or more of statutory capital or rights of vote in legal entity is not an obligatory condition allowing to determine physical person as final beneficiary owner (controller)dPlease pay attention that JSC Ukrgasvydobuvanny (further the Company) requires submission of the below information guided by the principles of the Law of Ukraine "On corruption prevention " and the Law of Ukraine "On sanctions", as well as to fulfill requirements of the nternal regulations of the Company and/or Naftogaz Group. Naftogaz Group means NJSC Naftogaz of Ukraine and its daughter companies founded by NJSC Naftogaz of Ukraine as well as enterprizes in which 50% or more shares (parts, equities) belongs to NJSC Naftogaz of Ukraine In case of insufficient space in any field of the form to indicate all information, please indicate complete information on the last or additional page and verify it with your signature and stamp (if available) making a remark in the respective field of Questionnaire " see last/additional page". To avoid misunderstanding, please provide complete replies to the questions, avoid dashes, skipping questions or giving replies such as "information/data is missing/unknown". In questions which foresee options of replies it is necessary to put a mark in the field at the answer variant which reflects the actual status most relevantly. In case the Questionnaire is filled in incorrectly and/or provided information is improper and/or requested information was not provided, establishing of business relationship may be rejectedAcutual address (if different)a6. Information on general manager or person authorized to manage Counterparty business activitiesCitizenship/residence60. Information on person (-s) who is (are) authorized by the Counterparty to represent his interests during procurement procedure (if appointed)Document providing respective rights of representation (with indication of its type - statement, power of attorney etc) and requisites - number and date)Part of ownership (%)3. Name and surname4. Name and surname68. Information on Counterparty structure of ownershipJIdentification code / Registration number (for residents - if available) 3. Name (full)8.3. Information of structure of ownership * to be provided in Annex to Questionnaire (information on ownership structure is obligatory for all Conterparties)\1**Structure of ownership - documentally confirmed system of interaction of legal entities and physical persons, trusts or other similar legal enterprizes which allows to detect all final beneficiary owners including controlling relationship between them, or absence of final beneficiary owners (controllers). Structure of ownership is an integral part of the Questionnaire, information and/or documents must contain information on structure of ownership based on which the Company may detect all existing final beneficiary owners (controllers) or their absence.  9. Do persons mentioned in fields 6-8 belong to politically exposed persons, persons close to or associated with politically exposed persons***?Q9.1. Do persons mentioned in fields 6-8 belong to politically exposed persons***?.Name and sur< name of politically exposed personFPosition under which the person belongs to politically exposed persons{9.2. Do persons mentioned in fields 6-8 belong to persons close to ****or associated with *****politically exposed persons?QName and surname of person close to or associated with politically exposed person4Level of association with politically exposed person ***Politically exposed persons- physical persons being national or foreign public officials or officials effecting political functions in international organizations. Foreign public officials - physical persons who perform of used to perform the below-listed public functions in foreign countries, namely: -head of the country, head of government, ministers (deputies); members of parliament or other bodies performing function of state legislative bodies; heads and members of boards of central banks or auditing chamber; members of supreme court, constitutional court and other court authorities decisions of which are not subject to appeal except for exclusive conditions; ambassadors extraordinary and plenipotentiary, charges d'affairs and heads of central bodies of military government; -heads of administrative, managing or supervisory bodies of state enterprises; members of administrative bodies of political parties. National public officials - physical persons who perform or used to perform during last three years the below-listed public functions in Ukraine, namely: -President of Ukraine, Prime-minister of Ukraine, members of Cabinet of Ministers of Ukraine and their deputies; head of continuosly functioning assisting body created by the President of Ukraine and his deputies; head and deputies of State affairs management; heads of administration (secretariats) of state bodies which are not public officers with ther positions belonging to category A;- Secretary and deputy Secretaries of National Security and Defecnce Council of Ukraine; -members of parliament of Ukraine; -Head and members of the Board of National bank of Ukraine, members of Council of National bank of Ukraine; -heads and judges of Constitutional court of Ukraine, Supreme Court of Ukraine and higher specialised Courts; -members of Supreme legal council, members of Supreme qualification committee of judges of Ukraine, members of Qualification and disciplinary committee of public prosecutors; -Chief Public Prosecutor of Ukraine and his deputies; -Head of Security Service of Ukraine and his deputies; -Director of National anticorruption bureau of Ukraine and his deputies; Head of State Investigation Agency and his deputies; Director of Economic Security Agency of Ukraine and his deputies; head and members of National council on TV and radio broadcast of Ukraine; -Head of Antimonopoly committee of Ukraine and his deputies; Head of National Agency of corruption prevention and his deputies; -Head and members of National Audit office; Head and members of Central Election Committee; heads and members of other state collegial bodies; ambassadors extraordinary and plenipotentiary; -Head of General Staff - Commander-in-chief of Ukraine, heads of Field Force of Ukraine, Air Force of Ukraine, Marine force of Ukraine, -state officers whose positions are ranked category A; -heads of oblast territory bodies of executive power, heads of prosecutor bodies, heads of oblast territory bodies of Security Service of Ukraine, heads and judges of appeal courts; -heads of administrative, managing or supervisory bodies of state and treasury enterprises, enterprises with state share in statutory capital exceeds 50 percent; -members of political parties management bodies. j*Final beneficial owner - any physical person who has decisive influence (control) on activities of the Counterparty and/or physical person from the name of which the financial operation is made. -for legal entities - any physical person who has decisive influence on legal entity activities (including via control/ownership chain), -for trusts founded in line with legislation of country of founding - founder, trusted owner, protector (if any), beneficial owner (beneficial party) as well as any physical person who has decisive influence on trust activities (including via control/ownership chain); - for other sililar legal entities - person having status equal or similar to persons indicated for trusts. Indicatives of direct decisive influence on activities are direct posession by physical person not less than 25 percent of statutory capital or rights of vote in the legal entity. Indicatives of indirect decisive influence on activities are posession by physical person of at least 25 percent of statutory capital or rights of vote in the legal entity via connected persons or legal entities, trusts or similar legal entities. Upon that, final beneficiary owner can not be a person having a formal right for 25 or more percent of statutory capital or rights of vote in the legal entity however being an agent, nominal holder (nominal owner) or an intermediate of such right.  j Close persons**** - persons married and children before their reaching lawful age - irrespective of their common living, any persons living commonly, linked by joined household and having mutual rights and obligations with national/foreign public officials (except for persons whose mutual rights and obligations with the subject have no family way) including the persons living commonly but not married and - irrespective of mentioned conditions - husband, wife, father, mother, step-father, step-mother, son, daughter, step-son, step-daughter, blood brother and cousin, blood sister and cousin, grandfather, grandmother, grandgrandfather, grandgrandmother, grandson, granddaughter, grandgrandson, grangranddaughter, son-in-law, daughter-in-law, father-in-law, mother-in-law, father and mother of husband (wife) of son (daughter), adoptive parent or child, foster parent or guardian, foster child or guarder to the mentioned person. Associated persons to politically exposed persons***** - physical persons meeting at least one criterion - known to have common beneficiary ownership of legal entity, trust or any other similar legal entity with politically exposed person or having any other close business relationship with politically exposed persons; are final beneficiary owners of legal entity, trust or any other legal entity known to be founded for benefit of olitically exposed persons.X]O10. Are persons indicated in Quesstionnaire linked to Naftogaz Group companies?10.1. Do persons indicated in Questionnaire work as manager* of any Naftogaz Group Company** and/or having substational participation in any Naftogaz Group Company:i10.2. In case of positive answer to the previous question, please indicate name of Naftogaz Group Companyi10.3 Do accociated persons* of the persons indicated in Questionnaire work in any Naftogaz Group Company:10.4 In case associated persons* of the persons indicated in Questionnaire work in Naftogaz Group Company (-ies), please indicate full name and surname and position of the associated person:*associated persons - husband or wife, direct relatives (father, mother, children, blood brothers and sisters, grandparents, grandchildren), direct relatives of husband or wife, husband or wife of the direct relative. **Naftogaz Group - NJC Naftogaz of Ukraine and daughter companies founded by NJC Naftogaz of Ukraine and enterprizes where 50% or more shares (parts, equities) belongs to NJC Naftogaz of Ukraine ***filled in only in case of presence of such relatives (associated persons) 11. Do sanctions of RNBOU (National Security Council of Ukraine) and/or OFAC of USA and/or EU and/or Great Britain and/or Security Concil of UN apply to Counterpary or to persons indicated in Questionnaire and/or in structure of ownership attached to the Questionnaire ?ECitizenship / residence / Country of registration (for non-residents))Identification code / Registration numberWho (country, authority) applied the sanction, under which normati<k ve/executive/court act, for which period, for which reason, list of limitations/prohibitions imposed by sanctionsb12. Does the Counterparty have appointed authorized person on corruption detection and prevention?12.1. If "yes" to the previous question, please indicate name and position of the authorized person responsible for corruption detection and prevention?12. Does the Counterparty have approved Anticorruption program?13.1. If "yes" to the previous question, please indicate the document by which the anticorruption program was approved (indicating document number and date)m13.2. Is Anticorruption program available at participant webpage? If yes, please indicate the link to webpage# In case of change of owner of substational shareholding of the Counterparty, change of Counterparty location, changes in statutory documents, expiry of submitted documents validity and other changes, in case of winning in procurement procedure and/or contract conclusion with the Company, we undertake to advise the Company of such changes within 5 (five) working days from such change. Information indicated in the Questionnaire is reliable.We confirm aquiaintance with Anticorruption program of the Company under the link https://ugv.com.uaStamp(if available) FORTH LINEFinal beneficiary owner - any physical person who has decisive influence (control) on activities of the Counterparty and/or physical person from the name of which the financial operation is made. Final beneficiary owner is: -for legal entities - any physical person who has decisive influence on legal entity activities (including via control/ownership chain), -for trusts founded in line with legislation of country of founding - founder, trusted owner, protector (if any), beneficial owner (beneficial party) or beneficial owners (beneficial parties) as well as any physical person who has decisive influence on trust activities (including via control/ownership chain); - for other sililar legal entities - person having status equal or similar to persons indicated for trusts. Indicatives of direct decisive influence on activities are direct posession by physical person not less than 25 percent of statutory capital or rights of vote in the legal entity. Indicatives of indirect decisive influence on activities are posession by physical person of at least 25 percent of statutory capital or rights of vote in the legal entity via connected persons or legal entities, trusts or similar legal entities. Upon that, final beneficiary owner can not be a person having a formal right for 25 or more percent of statutory capital or rights of vote in the legal entity however being an agent, nominal holder (nominal owner) or an intermediate of such right.Nominal holder -person which manages from his name the corporate rights of the other person - final beneficiary owner in the interest of the latter._! 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