IZJAVA O STATUSU FUNKCIONERA / PEP STATEMENT

1. Ime i prezime / First and last name:

2. Adresa prebivališta ili boravišta / Address of residence or temporary residence:

3. Datum i mesto rođenja / Date and place of birth:

4. Broj telefona i e-mail / Phone number and e-mail:

5. Vrsta i broj identifikacionog dokumenta, naziv izdavaoca, datum i mesto izdavanja / Type and number of ID document, name of the issuer, date and place of issue:

@error('is_official') 6. Da li ste Vi, Vaš bliži saradnik ili član uže porodice obavljali u poslednje 4 godine visoku javnu funkciju (detaljno objašnjenje) / Do you, or your close relative or associate perform or have performed a public function over the last 4 years: {{ $message }} @else 6. Da li ste Vi, Vaš bliži saradnik ili član uže porodice obavljali u poslednje 4 godine visoku javnu funkciju (detaljno objašnjenje) / Do you, or your close relative or associate perform or have performed a public function over the last 4 years: @enderror

DA/YES

NE/NO

@error('public_function') 7. Vrsta javne funkcije / What public function do you perform or have performed: {{ $message }} @else 7. Vrsta javne funkcije / What public function do you perform or have performed: @enderror

@error('period') 8. Period obavljanja javne funkcije / Period in which you perform or have performed the public function: {{ $message }} @else 8. Period obavljanja javne funkcije / Period in which you perform or have performed the public function: @enderror

@error('family_relationship') 9. Navedite podatke o porodičnom odnosu / What is your family relationship (if you are a close family member of a PEP): {{ $message }} @else 9. Navedite podatke o porodičnom odnosu / What is your family relationship (if you are a close family member of a PEP): @enderror

@error('business_relationship') 10. Navedite podatke o vrsti poslovne saradnje / What is the type of business relationship (if you are a close associate of a PEP): {{ $message }} @else 10. Navedite podatke o vrsti poslovne saradnje / What is the type of business relationship (if you are a close associate of a PEP): @enderror

@error('property_origin') 11. Molim Vas navedite poreklo imovine koja ce biti predmet poslovnog odnosa / Please state the origin of the property of the business relationship: {{ $message }} @else 11. Molim Vas navedite poreklo imovine koja ce biti predmet poslovnog odnosa / Please state the origin of the property of the business relationship: @enderror

Zarada / Salary;

Ugovor (zakup, kupoprodaja nepokretnosti, pokloni, pomoć i ostalo), rešenje o nasleđivanju, faktura / Contract;

Drugo / Other

@error('property_origin_other') Navesti: {{ $message }} @enderror

@error('information_availability') 12. Da li su podaci o vašoj celokupnoj imovini javno dostupni / Is your comprehensive property information publicly available: {{ $message }} @else 12. Da li su podaci o vašoj celokupnoj imovini javno dostupni / Is your comprehensive property information publicly available: @enderror

DA/YES

NE/NO

@error('publicly_available_source') 13. Ukoliko je odgovor na prethodno pitanje DA navedite nam naziv javno dostupnog izvora / If the answer on the previous question is YES, please provide us with the name of the publicly available source: {{ $message }} @else 13. Ukoliko je odgovor na prethodno pitanje DA navedite nam naziv javno dostupnog izvora / If the answer on the previous question is YES, please provide us with the name of the publicly available source: @enderror

@error('comprehensive_property') 14. Ukoliko je odgovor na prethodno pitanje NE navedite podatke o celokupnoj imovini koju posedujete / If the answer on the previous question is NO, please provide us with data of the comprehensive property which is owned by you: {{ $message }} @else 14. Ukoliko je odgovor na prethodno pitanje NE navedite podatke o celokupnoj imovini koju posedujete / If the answer on the previous question is NO, please provide us with data of the comprehensive property which is owned by you: @enderror

15. Dozvoljavam obvezniku, da u svrhu provere istinitosti podataka dobijenih izjavom, samostalno proveri podatke o meni kao stranci na osnovu uvida u javne ili druge dostupne evidencije podataka, odnosno da ih proveri neposredno kod nadležnih organa druge države, pri konzularnom predstavništvu ili ambasadi te države u Republici Srbiji, odnosno Ministarstvu spoljnih polova Republike Srbije / I allow the obligee, for the purpose of verifying the veracity of the data obtained by the statement, to independently check the information about me as the client based on the inspection of public or other available data records, i.e. to check them directly with the competent authorities of another country, at the consular representation or embassy of that country in the Republic of Serbia, i.e. the Ministry of Foreign Affairs of the Republic of Serbia

U Beogradu, {{ date('d.m.Y.') }}

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Potpis klijenta/punomoćnika

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Potpis službenika Društva

Funkcioner je fizičko lice koje obavlja ili je u poslednje četiri godine obavljalo visoku javnu funkciju koja ga čini domaćim funkcionerom (1), strani funkcionerom (2) i funkcionerom međunarodne zajednice (3) / PEP official is a physical person who perform or has been performing a high public function in the last four years, which makes him a domestic official (1); a foreign official (2) or an official of the international organization (3)

(1) Funkcioner Republike Srbije: predsednik države, predsednik Vlade, ministar, državni sekretar, posebni savetnik ministra, pomoćnik ministra, sekretar ministarstva, direktor organa u sastavu ministarstva i njegovi pomoćnici, i direktor posebne organizacije, kao i njegov zamenik i njegovi pomoćnici,narodni poslanik, sudija Vrhovnog kasacionog, Privrednog apelacionog i Ustavnog suda, predsednik, potpredsednik i član saveta Državne revizorske institucije, guverner, viceguverner, član izvršnog odbora i član Saveta guvernera Narodne banke Srbije, lice na visokom položaju u diplomatsko-konzularnim predstavništvima (ambasador, generalni konzul, otpravnik poslova), član organa upravljanja u javnom preduzeću ili privrednom društvu u većinskom vlasništvu države, član organa upravljanja političke stranke; član uže porodice funkcionera jeste bračni ili vanbračni partner, roditelji, braća i sestre, deca, usvojena deca i pastorčad, i njihovi bračni ili vanbračni partneri; bliži saradnik funkcionera jeste fizičko lice koje ostvaruje zajedničku dobit iz imovine ili uspostavljenog poslovnog odnosa ili ima bilo koje druge bliske poslovne odnose sa funkcionerom (npr. fizičko lice koje je formalni vlasnik pravnog lica ili lica stranog prava, a stvarnu dobit ostvaruje funkcioner) / PEP official of the Republic of Serbia: the president of the state, the prime minister, the minister, the state secretary, the special adviser to the minister, the assistant minister, the secretary of the ministry, the director of the body within the ministry and his assistants, and the director of a special organization, as well as his deputy and his assistants, a member of parliament, a judge of the Supreme Court of Cassation, the Commercial Court of Appeal and the Constitutional Court, president, vice-president and member of the council of the State Audit Institution, governor, vice-governor, member of the executive board and member of the Council of Governors of the National Bank of Serbia, a person in a high position in diplomatic and consular missions (ambassador, consul general, chargé d'affaires affairs), a member of the management body in a publicly held company or a company majority-owned by the state, a member of the management body of a political party; a member of the official's immediate family is a spouse or common-law partner, parents, brothers and sisters, children, adopted children and stepchildren, and their spouse or common-law partners; a close associate of an official is a natural person who realizes a joint profit from property or an established business relationship or has any other close business relationship with the official (e.g. a natural person who is the formal owner of a legal entity or a foreign legal entity, and the real profit is realized by the official);

(2) Funkcioner druge države: šef države i/ili vlade, član vlade i njegov zamenik, izabrani predstavnik zakonodavnog tela, sudija vrhovnog i ustavnog suda ili drugog sudskog organa na visokom nivou, protiv čije presude, osim u izuzetnim slučajevima, nije moguće koristiti redovni ili vanredni pravni lek, član računskog suda, odnosno vrhovne revizorske institucije i članovi organa upravljanja centralne banke, ambasador, otpravnik poslova i visoki oficir oružanih snaga, član upravnog i nadzornog organa pravnog lica koje je u većinskom vlasništvu strane države, član organa upravljanja političke stranke / PEP official of another state: the president of the state and/or the prime minister, a member of the government and his deputy, an elected representative of the legislative body, a judge of the supreme and constitutional courts or another high-level judicial body, against whose judgment, except in exceptional cases, it is not possible to use a regular or extraordinary legal remedy, member audit court, i.e. supreme audit institution and members of the central bank's management body, ambassador, chargé d'affaires and senior officer of the armed forces, member of the administrative and supervisory body of a legal entity that is majority owned by a foreign state, member of the management body of a political party;

(3) Funkcioner međunarodne organizacije: direktor, zamenik direktora, član organa upravljanja, ili drugu ekvivalentnu funkciju u međunarodnoj organizaciji / PEP official of an international organization: director, deputy director, member of the managing body, or other equivalent function in an international organization;

(4) Bliži saradnik funkcionera jeste fizičko lice koje ostvaruje zajedničku dobit iz imovine ili uspostavljenog poslovnog odnosa ili ima bilo koje druge bliske poslovne odnose sa funkcionerom / A close associate of an PEP official is a natural person who realizes a joint profit from property or an established business relationship or has any other close business relationship with the official;

(5) Član uže porodice funkcionera jeste bračni ili vanbračni partner, roditelji, braća i sestre, deca, usvojena deca i pastorčad, i njihovi bračni ili vanbračni partneri / A member of a PEP official's close family is a spouse or common-law partner, parents, brothers and sisters, children, adopted children and stepchildren, and their spouse or common-law partners.