JOINT-STOCK COMPANY

COMMERCIAL BANK «PRIVATBANK»

Registered address:
1D Hrushevskoho St., Kyiv, 01001, Ukraine
Contact us:
30 Naberezhna Peremohy St., Dnipro, 49094, Ukraine
Phones: 3700 (free from mobile in Ukraine)
(056) 735 32 82
www.pb.ua e-mail: help@pb.ua
from 09.06.2021 13:20 № L0HVMA4HO4DICPOL Page 1 of 3

POLCHENKO VIACHESLAV
TIN: 3046801192, date of birth: 02.06.1983
NATIONAL PASSPORT МР 403561, issued by OLESHKIVSKYI RAIONNYI SEKTOR UPRAVLINNIA DERZHAVNOI MIHRATSIINOI
SLUZHBY UKRAINY V KHERSONSKII OBLASTI date of issue 23.08.2013
Registration address: Ukraine, 75100, region Khersonska, district Oleshkivskii, city Oleshki, street Stakhanova, building 22a

Statement of card/account 414943******2399 (UA463052990000026203887512113) of agreement SAMDNWFC00060038419 on

03.06.2020 for the period 01.05.2021 — 31.05.2021
Credit limit: 0.00 Total outflow: 4,367.32
Account currency:UAH Total inflow: 4,360.17
Opening balance: 0.00 Amount of charges: 27.26
Ending balance: 245.65 Amount of discounts: 0.00

Amount in Amount Amount Amount Balance

Transaction
Account Transaction details transaction in card of of after
date
currency currency charges discounts transaction
414943******2399 -36.00
26.05.2021 Contract No. SAMDNWFC00060038419 Transfer from your card -36.00 5.00 0.00 0.19
from 03.06.2020
UAH

Payment for services via

414943******2399 Privat24. Payee: Rostkom, -51.00
25.05.2021 Contract No. SAMDNWFC00060038419 -51.00 1.00 0.00 36.19
from 03.06.2020
OOO. Code receipts: 9233-6281- UAH
8773-4038
414943******2399 Depositing the transfer to the 77.00
25.05.2021 Contract No. SAMDNWFC00060038419 77.00 0.00 0.00 87.19
from 03.06.2020
card UAH

414943******2399 Food: Silpo, Kherson, m. -73.96

23.05.2021 Contract No. SAMDNWFC00060038419 -73.96 0.00 0.00 10.19
from 03.06.2020
Kherson, prosp.Ushakova,bud.49 UAH

414943******2399 Tourism and transport services:

-22.30
22.05.2021 Contract No. SAMDNWFC00060038419 AS PRYMISKA KHERSON, -22.30 0.00 0.00 84.15
from 03.06.2020
UAH
KHERSON
414943******2399 Transfer from PrivatBank card
100.00
21.05.2021 Contract No. SAMDNWFC00060038419 via Privat24. Sender: Kuzmenko 100.00 0.00 0.00 106.45
from 03.06.2020
UAH
Milana Oleksandrivna
ATM cash withdrawal: Shopping
414943******2399 Center Elektromash, C -500.00
18.05.2021 Contract No. SAMDNWFC00060038419 -505.00 5.00 0.00 6.45
from 03.06.2020
KHERSON, AVE USHAKOVA, UAH
57
414943******2399 Depositing the transfer to the 500.00
18.05.2021 Contract No. SAMDNWFC00060038419 500.00 0.00 0.00 511.45
from 03.06.2020
card UAH

Payment services via Privat24.

Recipient: UPRAVLENYE
414943******2399 OBRAZOVANYIAPO DELAM -589.00
16.05.2021 Contract No. SAMDNWFC00060038419 -589.00 1.00 0.00 11.45
from 03.06.2020
SEMY MOLODEZhY Y SPORTA UAH
OHS. Code receipts: 9232-7447-
5442-4346
Your card replenishment with
414943******2399 cash in cash-in ATM: Oleshki, st. 600.00
16.05.2021 Contract No. SAMDNWFC00060038419 600.00 0.00 0.00 600.45
from 03.06.2020
Proletarska, build.. B/n, Zona 24 UAH
/7.
JOINT-STOCK COMPANY
COMMERCIAL BANK «PRIVATBANK»
Registered address:
1D Hrushevskoho St., Kyiv, 01001, Ukraine
Contact us:
30 Naberezhna Peremohy St., Dnipro, 49094, Ukraine
Phones: 3700 (free from mobile in Ukraine)
(056) 735 32 82
www.pb.ua e-mail: help@pb.ua
from 09.06.2021 13:20 № L0HVMA4HO4DICPOL Page 2 of 3

Amount in Amount Amount Amount Balance

Transaction
Account Transaction details transaction in card of of after
date
currency currency charges discounts transaction
414943******2399 Mobile phone account -58.00
07.05.2021 Contract No. SAMDNWFC00060038419 -58.00 2.00 0.00 0.45
from 03.06.2020
replenishment +380978790275 UAH

414943******2399 -2,010.00
07.05.2021 Contract No. SAMDNWFC00060038419 Transfer from your card -2,010.00 10.00 0.00 58.45
from 03.06.2020
UAH

414943******2399 Transfer from your card 41**54 299.49

07.05.2021 Contract No. SAMDNWFC00060038419 299.49 0.00 0.00 2,068.45
from 03.06.2020
via Privat24 UAH

414943******2399 Transfer to your card 41**54 via -51.00

07.05.2021 Contract No. SAMDNWFC00060038419 -51.26 0.26 0.00 1,768.96
from 03.06.2020
Privat24. UAH

414943******2399 Transfer from your card 41**54 1,769.00

07.05.2021 Contract No. SAMDNWFC00060038419 1,769.00 0.00 0.00 1,820.22
from 03.06.2020
via Privat24 UAH

414943******2399 Food: MAGAZIN Y NATALI, -64.50

07.05.2021 Contract No. SAMDNWFC00060038419 -64.50 0.00 0.00 51.22
from 03.06.2020
TSIURUPYNSK UAH

414943******2399 Food: PR865, Tsiurupynsk, -143.80

07.05.2021 Contract No. SAMDNWFC00060038419 -143.80 0.00 0.00 115.72
from 03.06.2020
Proletarskaia, 122A UAH

Payment for services via

414943******2399 Privat24. Payee: Khersonskaia -742.30
07.05.2021 Contract No. SAMDNWFC00060038419 -742.30 3.00 0.00 259.52
from 03.06.2020
oblastnaia EK, OOO. Code UAH
receipts: 9231-8433-6735-8299
Your card replenishment with
414943******2399 cash in cash-in ATM: Oleshki, st. 1,000.00
07.05.2021 Contract No. SAMDNWFC00060038419 1,000.00 0.00 0.00 1,001.82
from 03.06.2020
Proletarska, build.. B/n, Zona 24 UAH
/7
414943******2399 Tourism and transport services:
-20.20
04.05.2021 Contract No. SAMDNWFC00060038419 AS PRYMISKA KHERSON, -20.20 0.00 0.00 1.82
from 03.06.2020
UAH
KHERSON
414943******2399 9.68
04.05.2021 Contract No. SAMDNWFC00060038419 Top-up of a card 9.68 0.00 0.00 22.02
from 03.06.2020
UAH

414943******2399 Depositing the transfer to the 5.00

03.05.2021 Contract No. SAMDNWFC00060038419 5.00 0.00 0.00 12.34
from 03.06.2020
card UAH

The certificate is issued to be provided upon request

Project Manager on Processing Head-Office Customer Documents Nikolaienko Yuliia

Formed by Privat24 self-service system

JOINT-STOCK COMPANY
COMMERCIAL BANK «PRIVATBANK»
Registered address:
1D Hrushevskoho St., Kyiv, 01001, Ukraine
Contact us:
30 Naberezhna Peremohy St., Dnipro, 49094, Ukraine
Phones: 3700 (free from mobile in Ukraine)
(056) 735 32 82
www.pb.ua e-mail: help@pb.ua
from 09.06.2021 13:20 № L0HVMA4HO4DICPOL Page 3 of 3

The facsimile seal and signature are used by agreement of the parties in accordance with Article 207 of the Civil Code of Ukraine
To view this document in electronic form:
1. Open page pb.ua/check 3. Enter the number of document and press "Search"
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