SWIFTNet FileAct Service Request for providing and modifying specifications

Equens SE Attn Customer Services P.O. Box 30500 3503 AH Utrecht Tel.: +31 (0) 30 283 6860 Fax: +31 (0) 30 283 6784

Please note! Submit a separate form for each request. Combined requests will be returned.

1 Type of Request (please tick one option only)

Request for production environment (fill in the entire form, except for section 9) Request for test environment (fill in the entire form, except for section 9) Change company details (fill in sections 2, 3, 4 and 10) Change contact person's telephone number and/or e-mail adress (fill in sections 2, 3, 4 and 10) Change specification(s) (fill in sections 2, 4 and 10, and the specifications to be changed) Register new contact person (fill in sections 2, 4, 9 and 10)

2 Company details
Name Business location Country Postcode City House number Suffix

NL SWIFT DN

o= 3 Contact person details

The contact person is the party responsible for the connection with Equens Name Telephonenumber E-mail

,o=swift (your SWIFT Distinguished Name)

4 Commencement date
Required commencement date (dd-mm-yyyy)

5 Compressed files
Do you want to receive all output files from Equens in ZIP format? No Yes

6 Output messages
Do you want to receive a message when an Equens output file is ready for you (NOT APPLICABLE FOR SWIFTNET FILEACT - NO TO BE FILLED) No by e-mail, adress:

7 SWIFT delivery notification

Do you want to receive a confirmation when your adressee has received the file you sent. For additional information regarding these specifications , please refer to SWIFT's SWIFTNet FileAct documentation. No SWIFT Delivery notification SWIFT Non-repudiation The recepient will be asked to send a delivery notification. This irrefutably records the delivery of a file. This option includes the 'SWIFT Delivery Notification'

8 Error messages
Please specify at which e-mail adress you would like to receive error messages
9.2924 version 1.0

At e-mailaddress

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Company Registration No. 30220519

SWIFTNet FileAct Service Request for providing and modifying specifications

9 Register a new contact person

When a new contact person is registered, the original contact person is automatically removed. Name Telephone number E-mail Signature:

Printing

Print form

We advise you to check the details carefully and print two copies. Keep one copy and send the original to Equens.

10 Signature
Name of banks legal representative Date (dd-mm-yyyy) Signature City Bank stamp

9.2924 version 1.0

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Company Registration No. 30220519