INCOME STATEMENT OF AN INDIVIDUAL Document TRANSLATION Form 2-NDFL document from Russian into English

(Document barcode number: 39908018)

Appendix No. 1
to the Order of the FNS of Russia
FNS (Federal Tax Service)
dated 30.10.2015
No. MMV-7_11/485@
Form 2-NDFL
Code according to KND 1151078
KND (Income Type Codes)
for 2015 yearN 1issued 03.08.2023
Type 1Number of corrections 00IFNS (Code) 7714
IFNS (Inspection of the Federal Tax Service)

1. Information about the tax agent

Code according to OKTMO 45333000Phone +7 (495) 941-61-64INN 7709602209KPP 771401001
OKTMO (Russian Classification of Municipal Territories)INN (Taxpayer Identification Number)KPP (Tax Registration Reason Code)
Tax Agent Limited Liability Company “ANT YAPY”

2. Information about the individual – recipient of the income

TIN in the Russian FederationTIN in the country of citizenship
Surname xxxFirst name xxxPatronymic name*
Еaxpayer status 1Date of Birth xxxxCitizenship (country code) 792
Code of the Identity Document: 10Series and Number of the Document xxxx
Residential Address in Russian Federation:Post Code 103274Region Code 77
DistrictCity Settlement
Street Krasnopresnenskaya NaberezhnayaBuilding xxx House numberApartment
Сountry of residence codeAddress

3. Incomes taxed at the rate of 13%

MonthIncome CodeIncome AmountDeduction CodeDeduction AmountMonthIncome CodeIncome AmountDeduction CodeDeduction Amount

🌐 Translation Services: Form 2-NDFL Document from Russian to English

4. Standard, social, investment and property tax deductions

Deduction CodeDeduction AmountDeduction CodeDeduction AmountDeduction CodeDeduction AmountDeduction CodeDeduction Amount

Notification, confirming the right to social tax deduction: No. ____ Date _____ IFNS code ____

Notification, confirming the right to property tax deduction: No. ____ Date _____ IFNS code ____

5. Total income and tax amounts

Total income amountxxxxxxWithheld tax amount16 364
Tax basisxxxxxxTransferred tax amount0
Assessed tax amount16 364Tax amount, overdeducted by tax agent0
Amount of fixed advance payments0Tax amount, not deducted by tax agent0

Notification confirming the right
to deduction of tax on fixed advance payments:

No. ____ Date _____ IFNS Code ____

Tax agent (1 – tax agent, 2 – authorized representative): 1

xxxxxx Tatyana Vladimirovna



Name of the document confirming representative’s powers_____

*Patronymic name to be stated, if any

Stamp(Stamp: Partially illegible. Unable to fully translate due to poor quality / damage / illegibility) , OGRN (Primary State Registration Number) 10 146585918 * MOSCOW * Limited Liability Company * ANT YAPY

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