* Company organisation number. * Name of contact person



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Reporting of pay and employment for two employees This is required in order to complete the A-melding Legal and enterprise organisation number, can be found in the Register of Legal Entities: brreg.no/ Employment contract for employee Payslip for employee Guidance for paper submissions may be found at www.altinn.no It is the most recently submitted form that counts in cases where several forms are being submitted for the same calendar month. 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 Number of pages submitted Number of employees Employer contact details Organisation number of declarant Address Company organisation number Postal no. Postal town Name of entity Telephone Name of contact person Email Signature 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 number of your tax collector: http://www.skatteetaten.no/kontonummer. An individual customer identification number (KID) is required when making a payment: http://www.skatteetaten.no/kid Advance tax deductions to pay (all employees) = To be rounded down to the nearest whole kroner 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 Employer's national insurance contributions to pay = To be rounded down to the nearest whole kroner

e) Hourly paid f) Salaried g) Fees h) Piecework i) Commission A101 A-meldingen About the employment Company org. number Calendar month (mm-yyyy) Employee Name of employee National ID no./ref. no.: International number (where a national ID no./d no. has not been issued) Tax identification number (TIN) Passport number Value added tax number (VAT) Social security number (SOCSEC) Advance tax deductions Start date of employment End date (where applicable) Occupation code Occupation codes can be found in the directory of occupations: http://www.ssb.no/a/yrke Type of employment Remuneration type insert one cross only Number of per week to which a full-time position equates Agreed FTE Dato of most recent change of FTE Date of most recent salary change a Ordinary employment b Maritime employment c Freelancers, contractors and fee recipients, etc d Pensions or other non-employment remunerations. For leave and layoffs Start date End date Percentage Leave Layoff For commuters j Norwegian commuters k Foreign commuters with a tax deduction card with standard deduction l Foreign commuters with a tax deduction card without the standard deduction For foreign employment m Foreign employees n Employee not covered by Norwegian national insurance legislation (specified in form A1/E101 or via notification from the Norwegian Labour and Welfare Administration) o Tax-resident abroad 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. For seafarers Number of onboard without reimbursement of petty expenses Number of onboard

Income and deductions Employee national ID no./ref. no. Company org. number 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 5 Public holiday supplement 6 Irregular supplement linked to worked Business/work-related travel Quantity Total amount 7 Irregular supplement linked to non-worked 41 Business travel lodging 8 Holiday pay 42 Subsistence expenses covered directly by the employer 9 Bonus 43 Travel overnight supplement 10 Directors' fees and remuneration/holding of office 44 Fixed car allowance 11 Severance pay, subject to withholding tax 45 Travel, other 12 Severance pay, not subject to withholding tax 46 Board subject to withholding tax 13 Other 47 Travel subsistence without overnight stay 48 Travel subsistence with overnight stay in a hotel 14 Pay following death 49 Travel subsistence with overnight stay in a guesthouse 15 Capital income 16 Tax-free compensation 17 Pay and other remuneration not liable for tax 18 Pay from labour market schemes 19 Pay in the event of compulsory liquidation or State guarantee 20 Tax-free income from employment for children under the age of 13 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 25 Seafarers' wage supplements, subject to withholding tax 26 Seafarers' wage supplements, not subject to withholding tax Kilometreage allowance Number of km Total amount Number of km Total amount Company cars Reg. number List price Taxable amount Total km driven Km between home-workplace tax Quantity Total Ordinary expense allowances Quantity Total amount For commuters - payments in kind amount 27 Telephone/broadband, etc. 61 Board 28 Overtime subsistence 39 National Insurance premiums and education and development fund premiums 50 Travel subsistence with overnight stays in a bedsit/portacabin/private accommodation 51 Travel subsistence with overnight stay in a hotel more than 28 52 Travel subsistence with overnight stays for drivers driving abroad 53 Ordinary car 54 Electric car 55 Other 56 Passenger supplements 57 Ordinary car 59 Other 60 Car outside standard regulations 62 Lodging For car outside standard regulations 29 Nuisance bonus 63 Housing 30 Other, subject to withholding tax 64 Savings on household costs 31 Other, not subject to withholding tax 65 Home visits, other Ordinary payments in kind tax Quantity Total amount Total amount For commuters - expense allowances 32 Telephone/broadband, etc. 66 Board 33 Benefit on loan interest 67 Lodging in own Portacabin/caravan 34 Taxable part of insurance (excluding group life) 68 Lodging 35 Other, subject to withholding tax 69 Home visits, km allowance 36 Other, not subject to withholding tax 70 Home visits, other

e) Hourly paid f) Salaried g) Fees h) Piecework i) Commission A101 A-meldingen About the employment Company org. number Calendar month (mm-yyyy) Employee Name of employee National ID no./ref. no.: International number (where a national ID no./d no. has not been issued) Tax identification number (TIN) Passport number Value added tax number (VAT) Social security number (SOCSEC) Advance tax deductions Start date of employment End date (where applicable) Occupation code Occupation codes can be found in the directory of occupations: http://www.ssb.no/a/yrke Type of employment Remuneration type insert one cross only Number of per week to which a full-time position equates Agreed FTE Most recent change of FTE Most recent change in salary a Ordinary employment b Maritime employment c Freelancers, contractors and fee recipients, etc d Pensions or other non-employment remunerations. For leave and layoffs Start date End date Percentage Leave Layoff For commuters j Norwegian commuters k Foreign commuters with a tax deduction card with standard deduction l Foreign commuters with a tax deduction card without the standard deduction For foreign employment m Foreign employees n Employee not covered by Norwegian national insurance legislation (specified in form A1/E101 or via notification from the Norwegian Labour and Welfare Administration) o Tax-resident abroad 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. For seafarers Number of onboard without reimbursement of petty expenses Number of onboard

Income and deductions Employee national ID no./ref. no. Company org. number 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 5 Public holiday supplement 6 Irregular supplement linked to worked Business/work-related travel Quantity Total amount 7 Irregular supplement linked to non-worked 41 Business travel lodging 8 Holiday pay 42 Subsistence expenses covered directly by the employer 9 Bonus 43 Travel overnight supplement 10 Directors' fees and remuneration/holding of office 44 Fixed car allowance 11 Severance pay, subject to withholding tax 45 Travel, other 12 Severance pay, not subject to withholding tax 46 Board subject to withholding tax 13 Other 47 Travel subsistence without overnight stay 48 Travel subsistence with overnight stay in a hotel 14 Pay following death 49 Travel subsistence with overnight stay in a guesthouse 15 Capital income 16 Tax-free compensation 17 Pay and other remuneration not liable for tax 18 Pay from labour market schemes 19 Pay in the event of compulsory liquidation or State guarantee 20 Tax-free income from employment for children under the age of 13 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 25 Seafarers' wage supplements, subject to withholding tax 26 Seafarers' wage supplements, not subject to withholding tax Kilometreage allowance Number of km Total amount Number of km Total amount Company cars Reg. number List price Taxable amount Total km driven Km between home-workplace tax Quantity Total Ordinary expense allowances Quantity Total amount For commuters - payments in kind amount 27 Telephone/broadband, etc. 61 Board 28 Overtime subsistence 39 National Insurance premiums and education and development fund premiums 50 Travel subsistence with overnight stays in a bedsit/portacabin/private accommodation 51 Travel subsistence with overnight stay in a hotel more than 28 52 Travel subsistence with overnight stays for drivers driving abroad 53 Ordinary car 54 Electric car 55 Other 56 Passenger supplements 57 Ordinary car 59 Other 60 Car outside standard regulations 62 Lodging For car outside standard regulations 29 Nuisance bonus 63 Housing 30 Other, subject to withholding tax 64 Savings on household costs 31 Other, not subject to withholding tax 65 Home visits, other Ordinary payments in kind tax Quantity Total amount Total amount For commuters - expense allowances 32 Telephone/broadband, etc. 66 Board 33 Benefit on loan interest 67 Lodging in own Portacabin/caravan 34 Taxable part of insurance (excluding group life) 68 Lodging 35 Other, subject to withholding tax 69 Home visits, km allowance 36 Other, not subject to withholding tax 70 Home visits, other