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Affidavit of an Applicant interested in participating in the Auction Rounds of the Tender, the subject of which is the quarterly and/or monthly band electricity delivery Identification data of an Applicant interested in participating in the Tender Company Name: Registered Office: Business ID: Registered in: acting on behalf of/ represented by: Contact Name, Telephone No., e-mail: (Hereinafter referred to as the "Applicant") declares that it is a participant in the electricity market and registered with OTE, a.s., with its Registered Office at Sokolovská 192/79, Prague 8 - Karlín, Business ID 26463318, and has concluded a contract with OTE, a.s. on the settlement of deviations, as defined in the Decree of the ERO No. 541/2005 Coll., as amended, that is valid and effective as of the 16th November 2015, and declares that it a) hold a licence for the production of electricity issued by the ERO in accordance with the Energy Act, for sources with a total installed capacity exceeding 20 MW, or a) hold a license for electricity trading issued by the ERO pursuant to Act No. 458/2000 Coll. and in the last closed 12 calendar months has traded at least 50 GWh of electricity to/from the CR transmission system, and in accordance with the following Terms and Conditions of the Tender meets the conditions required of a Tenderer for the Auction Rounds of the Tender, the subject of which is the quarterly and/or monthly band electricity delivery, and will comply with the conditions required of the Tenderer also at the time of submission of bids to the relevant Auction Rounds of the Tender, the subject of which is the quarterly and/or monthly band electricity delivery. The Applicant further states that it has become acquainted with the Terms and Conditions of the Tender and their Appendices, as amended on 13th November 2015, and that it fully agrees with these Terms and Conditions of the Tender. In on ....…..…………….………………………………………. Applicant Signature* of the statutory or authorised representative * an officially certified signature is not required Terms and Conditions of the Tender (purchasing electricity to cover losses) Appendix 1_2 Page 1 (of 1)