SUPPLEMENTARY INFORMATION FOR THE LEASE LIMIT APPLICATION 1. Applicant s data Company s name (address, phone) NIP (VAT) and REGON numbers Contact person 2. PPROPERTIES HELD Address Type of property Property Register no. ha Market value Total mortgage encumbrances 3. Company s business activities: Share of the range of goods in sales Sale of farming machinery [%] share in revenue 4. Capital/ organisational/ personal relations within Group of Companies: Company s name and address Type of relation [%] of shares Equity in [PLN k] 5. Number of persons employed:............ 6. Sale structure: DOMESTIC:............ % EXPORT:............ % 7. Major customers Company s name/ country Products [%] share in sales Terms of payment [days] How long has been the cooperation? [years] Individual customers 1
8. Major suppliers: Name Products [%] share in purchases Terms of payment How long has been the cooperation? [years] 9. Major competitors and company s market position (strengths/weaknesses): 10. Existing credits and loans as of 31-12-2014 Credit / loan type Lender Credit given Current debt Maturity date 11. Existing leases (except IKB Leasing Polska Sp. z o.o.) as of 31-12-2014 Lessor Leased assets Current debt Lease expiration 12. Receivables structure (paid on time/ overdue) as of 31-12-2014 Total Current items up to 30 days items 30-90 days Including overdue items over 90 days 2
13. Liabilities structure (paid on time/ overdue) as of 31-12-2014 Total Current items up to 30 days Including overdue items 30-90 days items over 90 days 14. For any loss occurred in the last full or current accounting period, specify the reasons - 15. Statement: I hereby represent that we have/have not any due liabilities to the Social Insurance Institution [ZUS] or Inland Revenue and we are/are not a party to any arrangements for payment of such liabilities to any of these two bodies. 16. I apply for a limit of EUR/PLN for the following objects: 17. Attachments: Balance Sheet and Income Statement for 2012, 2013 and a up-to-date b PIT tax returns for 2012, 2013 c No arrears certificates issued by ZUS and Inland Revenue This filled in Supplementary Information including information on assets and liabilities except those relating to the d business conducted, plus signed data base consents Licensed auditor s opinion and report, financial statements e and notes to the financial statements* *where applicable Yes No date, signed 3
Information on assets and liabilities except those relating to the business conducted Full name Address, phone Pesel ID no. Marital status (separation of property) Company s name (address, phone) SHARES IN OTHER ENTITIES Entity s name and address Number of shares Nominal value Estimated current total market value REAL PROPERTY Address Type of property Property Register no. Date of purchase Market value Total mortgage encumbrances Other property (machines, devices, movable property above PLN 100 k) Type Estimated market value Encumbrances Receivables (e.g. loans extended) Debtor s name and address Type of receivables Total amount of receivables Due date Collateral 4
Loans/ credits/ leases/ warranties, guarantees given Lender s name and address Type of liability Total liability Maturity date Collateral Court, enforcement, composition, bankruptcy, restructuring proceedings - personal or relating to businesses conducted Total liability Type of proceeding Main creditors covered by the proceeding Term Guarding Equipment Aware of civil and criminal liability, I represent that all information provided by me in the personal financial statement is true and correct. Place, date Signed by the person making the statement 5