Address. Postcode. Telephone. . This form covers the period (calendar month and year) (mm-yyyy)

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1 Reporting of pay and employment for two employees Number of pages submitted Number of employees This is required in order to complete the A-melding The Norwegian legal organisation and the business (s), are found in the Register of Legal Entities: Employment contract for employee Payslip for employee Guidance for paper submissions is found at All amounts must be quoted in Norwegian kroner If you submitt several a-meldings on paper for the same calendar month, the last submission is valid (per business ). All compulsory fields (marked with ) must be completed each time, even in cases where there have been no changes since the previous submission. The form must be sent to: A-meldingen Postboks 4329 NO-2308 Hamar Norway Employer contact details Norwegian organisation Address Norwegian business Postcode Town/city Name of enterprise Telephone Name of contact person Signature This form covers the period (calendar month and year) Date Signature (mm-yyyy) Payment Employer's national insurance contributions and advance tax deductions must be paid to the tax collector every other month. Account for your tax collector: An individual customer identification (KID) is required when making a payment: Please note that there is one KID for employer's national insurance contributions and one KID for advance tax deductions. Advance tax deductions to pay (all employees) = To be rounded down to the nearest krone Employer's national insurance contributions Basis Refund Pensions Zone Rate Calculated contributions General industries Sector-exempt activity Agriculture, forestry and fishing Road freight transport Svalbard Employees sent from USA/Canada Seamen with fixed tax rate Employer's national insurance contributions to pay = kr To be rounded down to the nearest whole kroner

2 e) Hourly paid f) Salaried g) Fees h) Piecework i) Commission A101 A-meldingen About the employment Norwegian organisation Calendar month (mm-yyyy) Employee Name of employee Norwegian ID (fnr og dnr) International (where a Norwegian ID has not been issued) Tax identification (TIN) Country Date of birth Passport Country Date of birth Value added tax (VAT) Country Date of birth Social security (SOCSEC) Country Date of birth Advance tax deductions To be rounded down to the nearest krone Start date of employment End date of employment (if applicable) Occupation code Occupation codes can be found in the directory of occupations: Type of employment Remuneration type Number of per week to which a full-time position equates Agreed FTE percentage Date of most Date of most recent change of recent salary FTE percentage change dd.mm.yyyy dd.mm.yyyy Please tick a, b, c, d or e If a, b or c please tick one box If you have selected a or b, all four fields must be filled in. a Ordinary employment b Maritime employment c Freelancers, contractors and fee recipients, etc d Pensions or other non-employment remunerations e Non-employment in connection with, for example, benefits from surrendered property, RF-1199 etc. For leave and layoffs Start date End date Percentage Leave Layoff For commuters (maximum one tick) j Norwegian commuters (can use the fields 61-71) k Foreign commuters with a tax deduction card with standard deduction (cannot use the fields as the commuter benefits are given through standard deductions) l Foreign commuters with a tax deduction card without the standard deduction (can use the fields 61-71) For foreign employment n Employee not covered by Norwegian national insurance legislation (specified in form A1/E101 or via notification from the Norwegian Labour and Welfare Administration) Country o Tax-resident abroad (affecting field 10 and 17) For maritime employment Ship register NOR Norwegian International Ship Register (NIS) International ship register (UTL) Vessel type Tourist Drilling platform Other Shipping area Domestic International

3 Income and deductions Employee, Norwegian ID (fnr og dnr) Norwegian organisation Calendar month (mm-yyyy) Pay and cash remunerations Quantity Total amount Deductions Total amount 1 Fixed salary 37 Trade union fees 2 Hourly wage 3 Overtime payment 38 Premium for pension schemes 4 Fixed supplement 40 Portacabin rent 39 National insurance premiums and education and development fund premiums 5 Public holiday supplement Business travel Quantity Total amount 6 Irregular supplement linked to worked 41 Business travel lodging 7 Irregular supplement linked to non-worked 43 Travel overnight supplement 8 Holiday pay 45 Travel, other 9 Bonus 46 Board subject to withholding tax 10 Directors' fees and remuneration/holding of office 47 Travel subsistence without overnight stay 11 Severance pay, subject to withholding tax 48 Travel subsistence with overnight stay in a hotel 12 Severance pay, not subject to withholding tax 49 Travel subsistence with overnight stay in a guesthouse 50 Travel subsistence with overnight stays in a 13 Other bedsit/portacabin/private accommodation 51 Travel subsistence with overnight stay in a hotel more than Travel subsistence with overnight stays for drivers 14 Pay following death driving abroad 15 Capital income Car Quantity Total amount 16 Tax-free compensation 44 Fixed car allowance 17 Pay and other remuneration not liable for tax (you must also fill in tax-resident abroad on the previous page, field o) 18 Pay from labour market schemes Kilometre allowans 19 Pay in the event of compulsory liquidation or State guarantee 53 Ordinary car 75 Kilometre allowance, subject to withholding tax 20 Tax-free income from employment for children under the age of Electric car 21 Seafarers wages paid to crew members on fishing, small whaling and sealing vessels 22 Salary earned abroad 23 Pay - not liable for tax for diplomatic or consular missions 24 Foreign seafarers - not liable for tax 55 Other vehicle 56 Passenger supplements Company cars Reg. List price Taxable amount 57 Ordinary car 25 Seafarers' wage supplements, subject to withholding tax 59 Other car 26 Seafarers' wage supplements, not subject to withholding tax 60 Car outside standard regulations Total driven Expense allowances Quantity Total amount Km between home-workplace 27 Telephone/broadband, etc. 76 Company car Reg. List price Taxable amount 28 Overtime subsistence 77 Company car Reg. Km Taxable amount 29 Nuisance bonus For commuters. You must also select j or l on the previous page. 30 Other, subject to withholding tax Payments in kind Quantity Total amount 31 Other, not subject to withholding tax 61 Board 62 Lodging Payments in kind Quantity Total amount 63 Housing 32 Telephone/broadband, etc. 64 Savings on household costs 33 Benefit on loan interest 65 Home visits, other 34 Taxable part of insurance (eg. group life) Expense allowances 72 Free board 66 Board 73 Free lodging 67 Lodging in own Portacabin/caravan 74 Free housing 68 Lodging (only foreign commuters) 35 Other, subject to withholding tax 69 Home visits, kilometre allowance 36 Other, not subject to withholding tax 70 Home visits, other

4 e) Hourly paid f) Salaried g) Fees h) Piecework i) Commission A101 A-meldingen About the employment Norwegian organisation Calendar month (mm-yyyy) Employee Name of employee Norwegian ID (fnr og dnr) International (where a Norwegian ID has not been issued) Tax identification (TIN) Country Date of birth Passport Country Date of birth Value added tax (VAT) Country Date of birth Social security (SOCSEC) Country Date of birth Advance tax deductions To be rounded down to the nearest krone Start date of employment End date of employment (if applicable) Occupation code Occupation codes can be found in the directory of occupations: Type of employment Remuneration type Number of per week to which a full-time position equates Agreed FTE percentage Date of most Date of most recent change of recent salary FTE percentage change dd.mm.yyyy dd.mm.yyyy Please tick a, b, c, d or e If a, b or c please tick one If box you have selected a or b, all four fields must be filled in. a Ordinary employment b Maritime employment c Freelancers, contractors and fee recipients, etc d Pensions or other non-employment remunerations e Non-employment in connection with, for example, benefits from surrendered property, RF-1199 etc. For leave and layoffs Start date End date Percentage Leave Layoff For commuters (maximum one tick) j Norwegian commuters (can use the fields 61-71) k Foreign commuters with a tax deduction card with standard deduction (cannot use the fields as the commuter benefits are given through standard deductions) l Foreign commuters with a tax deduction card without the standard deduction (can use the fields 61-71) For foreign employment n Employee not covered by Norwegian national insurance legislation (specified in form A1/E101 or via notification from the Norwegian Labour and Welfare Administration) Country o Tax-resident abroad (affecting field 10 and 17) For maritime employment Ship register NOR Norwegian International Ship Register (NIS) International ship register (UTL) Vessel type Tourist Drilling platform Other Shipping area Domestic International

5 Income and deductions Employee, Norwegian ID (fnr og dnr) Norwegian organisation Calendar month (mm-yyyy) Pay and cash remunerations Quantity Total amount Deductions Total amount 1 Fixed salary 37 Trade union fees 2 Hourly wage 38 Premium for pension schemes 3 Overtime payment 39 National insurance premiums and education and development fund premiums 4 Fixed supplement 40 Portacabin rent 5 Public holiday supplement Business travel Quantity Total amount 6 Irregular supplement linked to worked 41 Business travel lodging 7 Irregular supplement linked to non-worked 43 Travel overnight supplement 8 Holiday pay 45 Travel, other 9 Bonus 46 Board subject to withholding tax 10 Directors' fees and remuneration/holding of office 47 Travel subsistence without overnight stay 11 Severance pay, subject to withholding tax 48 Travel subsistence with overnight stay in a hotel 12 Severance pay, not subject to withholding tax 49 Travel subsistence with overnight stay in a guesthouse 50 Travel subsistence with overnight stays in a 13 Other bedsit/portacabin/private accommodation 51 Travel subsistence with overnight stay in a hotel more than Travel subsistence with overnight stays for drivers 14 Pay following death driving abroad 15 Capital income Car Quantity Total amount 16 Tax-free compensation 44 Fixed car allowance 17 Pay and other remuneration not liable for tax (you must also fill in tax-resident abroad on the previous page, field o) 18 Pay from labour market schemes Kilometre allowans 19 Pay in the event of compulsory liquidation or State guarantee 53 Ordinary car 20 Tax-free income from employment for children under the age of Electric car 21 Seafarers wages paid to crew members on fishing, small whaling and sealing vessels 22 Salary earned abroad 23 Pay - not liable for tax for diplomatic or consular missions 24 Foreign seafarers - not liable for tax 75 Kilometre allowance, subject to withholding tax 55 Other vehicle 56 Passenger supplements Company cars Reg. List price Taxable amount 57 Ordinary car 25 Seafarers' wage supplements, subject to withholding tax 59 Other car 26 Seafarers' wage supplements, not subject to withholding tax 60 Car outside standard regulations Total driven Expense allowances Quantity Total amount Km between home-workplace 27 Telephone/broadband, etc. 76 Company car Reg. List price Taxable amount 28 Overtime subsistence 77 Company car Reg. Km Taxable amount 29 Nuisance bonus For commuters. You must also select j or l on the previous page. 30 Other, subject to withholding tax Payments in kind Quantity Total amount 31 Other, not subject to withholding tax 61 Board 62 Lodging Payments in kind Quantity Total amount 63 Housing 32 Telephone/broadband, etc. 64 Savings on household costs 33 Benefit on loan interest 65 Home visits, other 34 Taxable part of insurance (eg. group life) Expense allowances 72 Free board 66 Board 73 Free lodging 67 Lodging in own Portacabin/caravan 74 Free housing 68 Lodging (only foreign commuters) 35 Other, subject to withholding tax 69 Home visits, kilometre allowance 36 Other, not subject to withholding tax 70 Home visits, other