To Be Printed out on the Company Letter Head Paper

To be printed out on the company letter head paper

Designation of a representative in relation with Value Added Tax

operating exclusively pursuant to Directive 2006/112/CE of

28/11/2006 (article 271-IV FTC et 242-0A to 242-0K ofannex II FTC)

I hereby, Surname, first name, position of the company officer….,

Acting on behalf of the following company, name and address of the company, company registration number,

Appoints the company SAS GMBA, 53 avenue Hoche, 75008 PARIS, n° SIRET 352644199

As a representative.

* This representative will accomplish the following(non-exhaustive list; check the relevant boxes):

Accomplish formalities and sign the registration documents (affiliation, removal or modification) of the company in France;

Proceed to accounting compliance (particularly in regards to invoices, accounting, etc);

Represent the company with the French Tax and Administrative Authorities, particularly in regards to signing, addressing and receiving documents, correspondence and request for information and returns ;

Send, file and sign the VAT returns ;

Pay VAT and related taxes;

Send, file and sign the Instrastat with the Customs Authorities;

File a claim with the Authorities;

File a request for refund of VAT for the company.

* Collection of the received sums and refund of VAT:

The subjected foreign company grants the representative a right to collect the restituted sums or the refunded VAT, the company must provide a special mandate established pursuant to the provisions of the Regulation of March 30, 1989 – of Monsieur the delegate of the State Minister, Finance Minister – relating to the simplification of the public spending regulation, reprised in instruction 3 D-2-99 of July 15, 1999.

Bank details (mention if it is the company of the representative information and enclose a statement):

Name and address of the banking establishment: ……………………………………………………………………………………………………………

Account number:

IBAN: ……………………………………………………………………………………………………………

SWIFT or BIC: …………………………………………………………………………………………………..

Mandatory: please specify the number of boxes checked:

The appointment of the representative is granted exclusively and is in effect as of (insert the date of the signature of this power of attorney)

This mandate will produce its effects until it is denounced by the representative or the appointing company, by mention to the Tax Authorities in charge of the VAT of the foreign company..

Place, (Date)

(Signature of the company representative)

I hereby Alain BOUDOT, acting on behalf of the company GMBA, 53 avenue Hoche, 75008 PARIS, n° SIRET 352644199,

Agreed to the herein appointment as a representative and commit to accomplish on behalf of the foreign company name and address, company registration number,the formalities indicated hereabove.

Paris ,

(Our signature)