Data of the Applicant (Please Fill in Legibly, in Print)

Please read the information carefully.

Application

For penalty waiver according to Section 29/A paragraph (3) of Act LXVII of 2013 on distance-based tolls payable for the use of motorways, expressways and main roads.

Data of the applicant (Please fill in legibly, in print):

Name:______

Zip code: ______City______

Street/Road/Etc. or

lot No.; P. O. Box:

House No.: ______Floor:______Apt.:______

Email:

Invoicing address (Please fill in legibly, in print):

Name:______

Zip code: ______City______

Street/Road/Etc. or

lot No.: ______

House No.: ______Floor:______Apt.:______

Email:______Phone:______

Tax No.:______

Bank account No.: ______-______-______

Additional data required for processing:

Penalty decision No.: ______

Route ticket No.: ______

I request the penalty to be refunded by transfer to the following account No.:

______-______-______

Name of the beneficiary, account holder:

______

______day______month 201__

______

Applicant’s signature

Corporate signature

In the case of Court Decision No. ______I request the refund of the related penalty according to Section 29/A paragraph (3) of Act LXVII of 2013 on distance-based tolls payable for the use of motorways, expressways and main roads.

I take cognizance of the fact that pursuant to Sections 29/A paragraph (3) the penalty can be waived only if it was levied at a unit tolled section being part of a main route that has a joint intersection with the motorway, and the person subjected to the penalty payment had a valid authorization for the use of the unit tolled sections sharing the intersection and being part of the given motorway at the time of the unauthorized use.

In accordance with the relevant statute, I hereby declare the following related to the route actually travelled by the vehicle (please enter the start, the waypoints and the destination; the numbers and types of the roads used; and in which kilometer sections you used them; indication of the intersection shared with the motorway).

______

______

______

______

______

In accordance with the above, I hereby additionally declare the following:

pursuant to Section 29/A paragraph (6) of Act LXVII of 2013, a toll amount difference payable by the applicant has occurred in the amount of

HUF ______and which amount has previously been paid by the applicant.

pursuant to Section 29/A paragraph (6) of Act LXVII of 2013 a toll amount difference payable by the applicant has occurred the accurate amount of which cannot be determined, therefore a lump sum in the amount of HUF 10,000 has previously been paid by the applicant as prescribed by the relevant statute.

pursuant to Section 29/A paragraph (6) of Act LXVII of 2013 a toll amount difference payable by the applicant has not occurred.

(Please indicate ONE of the above listed options.)

You can calculate the toll payable for the route actually travelled by your vehicle by using the route planning application on the HU-GO web site. You cannot pay your route ticket thus planned; please print it and attach a copy of it in an annex to your application.

Please note that, unless otherwise prescribed in the relevant statutes, if the toll payable for the actually travelled route is less than the price of the route ticket serving as the basis for the penalty refund, then we cannot refund any part of the price of the route ticket.

Annexes:

• A copy of the penalty decision or – in case of a binding decision – of the binding decision concerned in the application
• A copy of the receipt of your payment of the HUF 12,000 service fee
• If payable toll amount difference has occurred, a copy of the receipt of your payment of the toll amount difference or the lump sum.
• A copy of the changed route ticket being the basis for the cancellation of your penalty (if available)
• A copy of the route plan prepared for the road actually travelled by the vehicle

I hereby acknowledge that I have been informed of the above conditions and accept all of their content.

______day______month 201__

______

Applicant’s signature

Corporate signature

Information about the additional conditions of the application
For penalty refund according to Section 29/A paragraph (3)

The service fees* can be paid separately for each penalty instance to the following bank account No.:

• 10402142-00027893-00000009 (K&H Bank, IBAN: HU06-1040-2142-0002-7893-0000-0009)

*Please send the service fee (HUF 12,000) to the above bank account only.

The toll amount difference or the lump sum* can be paid separately for each penalty instance to the following bank account No.:

• 10402142-00027894-00000008 (K&H Bank, IBAN: HU77-1040-2142-0002-7894-0000-0008)

**Please send the toll amount difference or the lump sum (HUF 10,000) to the above bank account only.

For easy identification of your payment, please indicate the following in the note section of your transfer:

• the identification number of the penalty decision
• the registration number of the vehicle concerned in the penalty decision
• your tax No.

In case of payment by transfer an electronic invoice is issued that is sent to the address specified by the Applicant in the Application.

Please note that if your payment cannot be conclusively identified by the data provided by the applicant, then the received amount minus the transfer service charge will be transferred back to the payer and the service fee/toll amount difference will be considered unpaid.

We would like to inform you that you can pay the service fee, the toll amount difference or the lump sum at one of our customer service offices also.

You can submit your Application within 60 days from the date when the statute enters into effect:

• by mail sent to 2101 Gödöllő, Postafiók 312 (please write the following designation on the envelope: “Bírság amnesztia” )
• in person at one of our Customer Service Offices.

Please attach the following documents to your Application:

• A copy of the penalty decision or – in case of a binding decision – of the binding decision concerned in the application
• A copy of the receipt of your payment of the service fee
• If payable toll amount difference has occurred, a copy of the receipt of your payment of the toll amount difference or the lump sum.
• A copy of the changed route ticket being the basis for the cancellation of your penalty (if available)
• A copy of the route plan prepared for the road actually travelled by the vehicle

Pursuant to Section 29/A paragraph (3), the Applicant is eligible for the waiver of the penalty levied for violation of Section 14 item a) of the Toll Road Act, on the basis of his/her application in accordance with paragraph (7) only if the said penalty was levied at a unit tolled section being part of a main route that shares an intersection with the motorway and the driver subjected to the penalty payment had valid road usage authorization at the time of the unauthorized road use for the unit tolled road sections being part of the given motorway and sharing the intersection.

Pursuant to Section 29/A paragraph (7) the Application can be submitted within 60 days from the date when Act ... of 2014 on the amendment of Act LXVII of 2013 on distance-based toll payable for the use of motorways, expressways and main roads enters into effect. Based on the Applicant’s Application, the toll charger will issue a statement – if the content of the application is in compliance with the relevant statutes, and are not in conflict with the data included in the toll charger’s data base – to the effect that the Applicant’s penalty payment can be waived, in consideration of Section 29/A paragraph (3).

Based on Section 29/A paragraph (6):

In addition to those contained in paragraph (3), another condition of the penalty waiver is that the Applicant has paid the service fee in the amount of HUF 12,000 for each penalty instance to the toll charger prior to the submission of his/her application and can verify such payment at the time of the submission of his/her application.

An additional condition of the penalty waiver in the case described in paragraph (3) is that prior to the submission of his/her application the Applicant has paid the toll difference, if applicable, between the toll relevant for the road for which the Applicant had road use authorization and the toll for the route which the Applicant actually used and can verify such payment at the time of the submission of his/her application. The Applicant must make a declaration related to his/her actually travelled route in his/her Application. If a toll difference payable by the Applicant has occurred but its amount cannot be determined based on the Application, or it cannot be verified by the Applicant, then he/she is obligated to pay a lump sum in the amount of HUF 10,000.

If as a result of the evaluation an Approval is issued, it will be sent by NTPS Plc. in pdf format in an email to the address specified by the Applicant in his/her Application. NTPS Plc. shall send the Approval directly to the authority levying the penalty also. In the event of a dispute, the Approval shall also be sent by mail to the Applicant upon the Applicant’s request.

Having regard to the fact that an email address is necessary for sending the invoice and the Approval, please be sure to provide your email address and double-check its accuracy.

In the event that our Company requests that missing documents be sent by the Applicant in connection with his/her Application, please send the missing documents within 15 days from the request.,

I hereby acknowledge that I have been informed of the above conditions and accept all of their content.

______day______month 201__

______

Applicant’s signature

Corporate signature

Valid: 2014.10.31 – 2015.06.30. / M-ÜK-01_13_v01 / 1. oldal, összesen: 3