Инвесторам

Holder's last name (for individuals)*

Holder's first name (for individuals)*

Patronymic (if available) (for individuals)

Holder's last name in Latin (for individuals)*

Holder's e-mail address*

The address of the place of residence (place of residence) of the holder of Eurobonds, who is an individual

Country*

Region

City*

Street*

House*

Housing

Flat*

Postal code*

Name of the country of residence (citizenship (nationality)) of the holder of Eurobonds*

ISIN-code(s) of purchased issue(-s)*

Quantity of Eurobonds (pcs.)

Nominal value of one Eurobond (USD)

Total nominal value of Eurobonds (USD)*

Place of accounting of Eurobonds owned by the holder (name of the depositary, country of the depositary)

Name of the depository*

Country of the depositary*

Date (dates) of Eurobond purchase*

The Eurobonds are unencumbered by covenants or other restrictions and (select as appropriate)*

Execution mechanism*

Preferred settlement currency

Accounts in the specified currency are opened with (specify name of financial institutions)*

Waiver of Claims. This document is for information purposes only. The document is not binding for completing. The document is not an application for redemption of the Eurobonds or fulfillment of obligations under the Resolution of the Council of Ministers of the Republic of Belarus as of 28 may 2024 y. №381 No.381 “About making certain operations with securities of joint-stock company “Development Bank of the Republic of Belarus” placed on foreign financial markets”. The fact of collection of this information and receipt of this information by the Development Bank does not constitute an obligation of the Bank to pay out funds on Eurobonds in favour of the person, who filled in or sent this form.

Инвесторам

Holders of Eurobonds of the Development Bank of Natural persons