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TRANSFER CONFIRMATION - DUPLICATE

mBank S.A. Retail

Banking
Post Office Box 2108, 90-959 Łódź 2

Transaction information
Account: (Sender) Account: Ma (Recipient)
Account no: 39 1140 2004 0000 3702 7912 1668 Account no: 81 1240 6960 7170 0013 8001 1044
Name of Bank: MBANK S.A. Name of the Bank: PEKAO Head Office - OOR 4
Sender: HO-BU POLSKA SPÓŁKA Z OGRANICZONĄ Recipient: INTERRISK TU S.A. VIENNA INSURANCE
ODPOWIEDZIALNOŚCIĄ GROUP
UL.KAZIMIERZOWSKA 6 M.13
62-800 KALISZ

Title of operation: APPLICATION/POLICY SERIES FPK-A/P NUMBER

Type of operation: 011044 OUTGOING EXTERNAL TRANSFER
Operation reference 79121668-000002204
number:

Date of operation: 2023-05-03

Posting date: 2023-05-03
Transfer amount: PLN 7 800.00

Date of issue of document: 2023-05-04

Electronically generated confirmation of the execution of a transfer. A document drawn up pursuant to Article 7 of the Banking
Act (Journal of Laws No. 140 of 1997, item 939, as amended). No signature or stamp required.

mBank S.A. Retail Banking

Post Office Box 2108, 90-959 Łódź 2 . www.mBank.pl
mLine: 801 300 800, +48 (42) 6 300 800