User Procedure

ANNEX 2 to the User Procedure

Participant Contact Information Form

Capitalized terms and expressions used in this Participant Contact Information Form shall have the respective meanings given to them in the Market Rules as amended from time to time and published in the Belgian Official Gazette, and in the Market Procedures as amended from time to time and published on the Belpex website.

Applicable situation (circle the right number):

  1. This Participant Contact Information Form is used by an Applicant/Person applying to be admitted as Indirect Participant[1]:

Applicant/Person applying to be admitted as Indirect Participant must only fill in part A (the information in part B being already communicated via the Application Form Admission and Access Belpex Spot Market)

The Form must be added to the application file (as Annex 1 to the Participation Agreement, or as Annex 1 to the Indirect Participation Agreement).

  1. The Participant Contact Information Form is used by a Participant/Indirect Participant* to communicate to Belpex a modification of the Participant Contact Information or (Indirect) Participant Contact Data*:

Participant/Indirect Participant must only fill in the fields that are subject to modification.

Participant/Indirect Participant must indicate the date on which the modification enters into effect taking into account that, according to the Market Rules, any change to the Participant Contact Information or (Indirect) Participant Contact Data must be communicated at least five Days before a modification enters into effect.

The Form must be faxed to the CSD.

A) Participant Contact Information

In situation 2), date modifications enter into effect:

(The given date must be at least 5 Days later than the submission date of the Participant Contact Information Form)

Contact Information Contractual aspects
Name:
Function:
Address:
Tel. Number:
Fax Number:
e-mail address:
Contact Information Financial aspects
Name:
Function:
Address:
Tel. Number:
Fax Number:
e-mail address:
Information Invoicing and Financial aspects
Invoicing Address:
Invoicing Fax Number:
VAT Registration Code:
Name Bank:
Address Bank:
Bank Account Number:
IBAN:
BIC-Code:

In case Applicant/Participant has its headquarters abroad, does it have a branch in Belgium (strike out what is not applicable): YES / NO

(please refer to the Fee, Invoicing and VAT procedure for a more detailed description of a “branch” and the VAT implications hereof)

If YES

Information regarding an eventual branch in Belgium
Branch Address:
Tel. Number:
Fax Number:
VAT Registration Code of branch:
Contact Information IT aspects
Name:
Function:
Address:
Tel. Number:
Fax Number:
e-mail address:
Contact Information Trading aspects, (including Manifest Error)
(For Indirect Participants: fill out information regarding Broker)
Name:
Function:
Address:
Tel. Number:
Fax Number:
e-mail address:
Contact Information ARP aspects (inclusive nominations)
Name:
Function:
Address:
Tel. Number:
Fax Number:
e-mail address:
Phone number on which (Indirect) Participant can be reached 24*7
Number (1):
Number (2):
(if applicable)

B)(Indirect) Participant Contact Data

Describe hereunder any changes in the (Indirect) Participant Contact Data as communicated to Belpex upon Application via the Application Form Admission and Access Belpex Spot Market:

Date on which these modifications enter into effect:

(The given date must be at least 5 Days later than the submission date of the Participant Contact Information Form)

[Description of the modifications. Fill only where there is a modification]

Name Applicant/Person applying to be admitted as Indirect Participant[2]:

Legal form of company:

Jurisdiction of incorporation:

Address (registered office/domicile):

City:

Country: Company number/commercial register number:

Other relevant identification number (with indication of nature of such identification number):

The Applicant/Participant/Person applying to be admitted as Indirect Participant/Indirect Participant* shall inform Belpex, in writing, immediately of any changes affecting the information given in the present form. Any changes of the information given in the present form shall only be binding to Belpex provided it has been submitted to Belpex by a duly completed Participant Contact Information Form.

Signature of authorized representative of Applicant/Participant/Person applying to be admitted as Indirect Participant/Indirect Participant*:
Date:
Name:
Function:
Tel:
Email:
Contract reference (Indirect) Participation Agreement (if applicable):

For Applicants: Form to be added to your application file (as Annex 1 to the Participation Agreement).

For Persons applying to be admitted as Indirect Participant: Form to be added to your application file (as Annex 1 to the Indirect Participation Agreement).

For (Indirect) Participants: Form to be faxed to the CSD.

Participant Contact Information

Form 1/4June 15th, 2011

[1]Strike out what is not applicable.