[ D. Application. Belastingdienst. For businesses established outside ofthe EU. Your registration number

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1 are wish do - - Belastingdienst Application VAT refund For businesses established outside ofthe EU Belastingdienst Limburg/kantoor buitenland RO. Box Di Heerlen The Netherlands Do you have a Dutch registration number? Your registration number [ D Receipt stamp Why this form? You can use this form to apply for a refund for the VAT that you have paid in the Netherlands as a business established outside ofthe European Union (cu). Who is this form intended for? You can use this form ifyou: a business established outside of the EU to apply for a Dutch VAT refund not file VAT returns in the Netherlands Ifyou are required to file VAT returns in the Netherlands, you can deduct the VAT that you have paid as input tax in your VAT return. In that case you cannot use this form. Completing and returning the form Fill in the application in Dutch, English or German. We must receive your application within 6 months of the end ofthe financial year for which you are applying for a VAT refund. Send the application to: Belastingdienst Limburg/kantoor buitenland, P0 Box zt6, Heeden, the Nethedands. More information For more information see Or call the BelasringTelefoon Buitenland: t S, from Monday to Thursday from t.oo a.m. to 8.oo p.m. and on Fridays from 8.oo to.oo p.m. Explanatory Notes Time period Your refund application must relate to a minimum period of 3 months and a maximum period of 1 calendar year. The refund period may be less than 3 months if it concerns a remaining part of 1 calendar year. Minimum amounts The refund you are applying for must be at least: 400 if your application concerns a time period of at least 3 months but not 1 full calendar year 50 if your application concerns a time period of at least 1 calendar year or the remaining part of 1 calendar year What should you enclose? Enclose with your application a statement showing that you are an entrepreneur subject to taxation in your own country. Have you already submitted a statement no more than 1 year old? If so there is no need to send another statement The application can relate to more than 1 invoice or import document. We will return the original documents to you. Explanation of the sections State in section 8 of this form the type of activity for which the goods or services have been delivered. By exempted transport services (section 9, option 3) we mean transport services in the context of international goods transport. That is mainly transport related to goods transit export or import The exemption for these transport services is subject to certain conditions. You can add appendices if sections 8 and 10 do not provide sufficient space. State your name, address and VAT number in appendices. Other information You must repay any amounts received in error. You should also enclose original invoices or import documents. These documents must show the amounts of VAT you have paid. V Details of your company a 1 Company name Street and door number Postcode and town/city Country Telephone number address Business activities 3 Tax office and registration number of the country where your business is established or where you have your place of residence or your usual residential address.

2 Application VAT refund for businesses established outside of the EU 2 F Your application 4 Time period to which the application relates (month/year) from 5 Total amount of the requested refund in whole euros (in figures). You must enter the details of the refund in section 10. [ 0 toj 6 You would like the refund to be transferred to: Account number IBAN BIC Name of the account holder Name and address of the bank 7 Number of appendices: Invoices: - Import documents: 8 The goods or services requesting a VAT refund were used for: 9 In the time period in which I am requesting the VAT refund, I: Check the applicable box. Signature 0 0 no goods or services delivered exclusively goods or services delivered over which the buyer of those goods or services is liable for the payment of tax exclusively certain exempted transport services and related services delivered Name Date Signature Forwarding address different from correspondence address? Do you want the decision and your original documents to be sent an address other than the one you have entered under 1? If so, enter here the address that we can send the documents to: Name Street and door number Postcode and town/city Country

3 Application VAT refund for businesses established outside of the EU 3 10 Summary of the VAT amounts in the time period to which this application relates (1/6) Serial Type of goods Name, VAT number Date and number number or services and address of of the invoice or the supplier import document LL :th - I I

4 -- Application VAT refund for businesses established outside of the EU 4 10 Summary of the VAT amounts in the time period to which this application relates (2/6) Serial Type of goods Name, VAT number Date and number number or services and address of of the invoice or the supplier import document z r

5 Application VAT refund for businesses established outside of the EU 5 10 Summary of the VAT amounts in the time period to which this application relates (3/6) Serial number Type of goods Name, VAT number or services and address of n ie the supplier L i Date and number of the invoice or import document -i EZJZ Li EELL E1E

6 Application VAT refund for businesses established outside of the EU 6 10 Summary of the VAT amounts in the time period to which this application relates (4/6) Serial Type of goods Name, VAT number Date and number number or services and address of of the invoice or the supplier import document ri L [ EZJ E - LIZ JZZH 1 1 L EZ.1

7 Application VAT refund for businesses established outside of the EU 10 Summary of the VAT amounts in the time period to which this application relates (5/6) Serial Type of goods Name, VAT number Date and number number or services and address of of the invoice or the supplier import document R1 Ii EZ1E LZ r 1

8 ----- Application VAT refund for businesses established outside of the EU 8 10 Summary of the VAT amounts in the time period to which this application relates (6/6) Serial Type of goods Name, VAT number Date and number number or services and address of of the invoice or the supplier import document 1 r L E1 F LZZZ1 1 -j L_J Total

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