[Single bidders/consortium members corporate name]

[Single bidders/consortium members registered address]

AD AERODROM NIKOLA TESLA BEOGRAD,

Surin, 11180 Beograd 59, Republic of Serbia,
and
GOVERNMENT OF THE REPUBLIC OF SERBIA,
Nemanjina 11, 11000 Belgrade, Republic of Serbia

Attention: []

In [location] on [date], 2017

Statement on compliance with the participation criterion1

All terms used herein shall have the same meaning as in the Public Invitation.

In the context of the Procedure conducted by the Republic of Serbia, represented by the Government
of the Republic of Serbia, and AD Aerodrom Nikola Tesla Beograd (jointly referred to as the Public
Body) with respect to a potential granting of a concession for the financing, development through the
construction and reconstruction, maintenance and management of the infrastructure of AD Aerodrom
Nikola Tesla Beograd and performance of the activity of airport operator at the Belgrade Nikola Tesla
airport,

[name of the bidder/consortium member], duly represented by [name and position of the
representative], empowered to act in the name and on behalf of [name of the bidder/consortium
member] by virtue of [evidence of power of attorney or corporate documents] dated [date], hereby
declares and undertakes that:

[name of the bidder/consortium member] has not, does not and will not, at any point in time
over a 12 months rolling period from January 1 st, 2016, directly or through Affiliates (as such
term is defined below), acquired, held or acquire or hold (directly or indirectly, including
through an agent) any interest representing more than twenty per cent (20%) of the share
capital or the voting rights of (i) any entity owning an airport engaged in the Competing
Business within the Restricted Territory (as such terms are defined below), or (ii) any
concessionaire of such airport engaged in the Competing Business within the Restricted
Territory or (iii) any owner of a PPP contract of an airport engaged in the Competing Business
within the Restricted Territory.

1 Statement to be signed by the statutory representative or authorized representative of the legal entity
which will act as single bidder or, if the bidder will be a consortium, by the statutory representative or
authorized representative of each consortium member.

1
[name of the bidder/consortium member] fully agrees that the continuing compliance with the above
declaration is a key prerequisite for [name of the bidder/consortium member]s involvement in the
Procedure.

When used in this statement and in accordance with the Public Invitation, the following terms shall
have the meanings ascribed to them below:

- Affiliate means either:

(a) any corporate entity Controlled by the bidder, or if the bidder is a consortium, by the
relevant consortium member,
(b) any corporate entity which Controls the bidder, or if the bidder is a consortium, the
relevant consortium member, and/or
(c) any corporate entity which is Controlled by the same parent company that Controls the
bidder, or if the bidder is a consortium, the relevant consortium member.

- Competing Business means the business, enterprise, operation or activity of an airport

serving at least 1 million passengers.

- Control as used with respect to any specified entity, means (i) the power to elect a majority
of the members of the board of directors (or other similar constituent body) of a legal entity,
and/or (ii) the direct or indirect holding of the majority of the voting rights or the share capital
of such legal entity.

- Restricted Territory means the area located within a 450 kilometers radius from the
Airport.

Sincerely,

_________________________________

On behalf of: [name of the bidder/consortium member]

By: [name of the bidders/consortium members representative]