NTG NORDIC A/S

TRUCKVEJ 5
4600 KGE

Hermed fremsendes faktura som aftalt.

Med venlig hilsen

Statoil Fuel & Retail A/S

31.10.2015
ROXY-LYZA SRL
BLVD. TINERETULUI NR. 14
BL. S2, SC. I, ET. 2, AP. 12
240021 RAMNICU VALCEA
RUMNIEN
Customer number: 0005272232

Statement for payment in Euro

Invoice 815645287 invoice date 31.10.2015

Total purchased this month

DKK

38.567,71

Total

EUR

5.171,46

Euro Exchange rate: 31.10.2015 : 7,4578

Please use following account:

IBAN number: EE03 1700 0170 0316 3966
SWIFT-BIC: NDEAEE2X

Best Regards
Statoil Fuel & Retail A/S

Statoil Fuel & Retail A/S

CVR: DK28142412

PO Box 120, 0900 Kbenhavn C

Borgmester Christiansens Gade 50, Kbenhavn SV

Telefon: (+47) 70 101 101

www.statoil.dk

SUMMARY
Reference:
Invoice date:

ROXY-LYZA SRL
BLVD. TINERETULUI NR. 14
BL. S2, SC. I, ET. 2, AP. 12
240021 RAMNICU VALCEA
RUMNIEN

815645287
31.10.2015

Customer number:
Customer CVR:

Amount:
Due date:

0005272232
RO18972664

38.567,71

Payment online bank / post office:

Statoil creditor: 81549699
See OCR reference at the bottom
Payment by bank transfer
Bank account: 2149 0728886242
IBAN: DK64 2000 0728 8862 42
SWIFT NEDEADKKK
Please specify reference: 815645287

Total invoiced purchases

Country of purchase / Specification

Amount excl.
VAT

Danmark
Sverige
Total invoiced:

Statistical VAT

Amount payable incl.

VAT DKK

30.050,38

7.512,59

37.562,97

1.004,74

0,00

1.004,74

31.055,12

7.512,59

38.567,71

ICC invoice no

7525525274

This summary can not be used for VAT refund, use ICC invoice.

Du kan tilmelde fremtidige fakturaer til automatisk betaling via LeverandrService.

Det kan gres i din bank. Medbring denne faktura til banken.
Statoils Kreditor nummer hos Nets LeverandrService : 12319
Du kan ogs kontakte Statoil, s kan vi tilmelde for dig.
Tilmelding til LeverandrService
LS kreditor: 00012319
Betalerref.: 000000011616658

Statoil Fuel & Retail A/S

CVR: DK28142412

+71<105272232000298 +81549699<

PO Box 120, 0900 Kbenhavn C

Borgmester Christiansens Gade 50, Kbenhavn SV

Telefon: (+47) 70 101 101

www.statoil.dk

INVOICE
ROXY-LYZA SRL
BLVD. TINERETULUI NR. 14
BL. S2, SC. I, ET. 2, AP. 12
240021 RAMNICU VALCEA
RUMNIEN

Invoice number:

815645287

Invoice date:

31.10.2015

Customer number:

0005272232

Customer VAT-no:

RO18972664

Page

1/2

Purchases in this period

Date

Time

Point of sale

Ver.no.

Product

Quantity

Gross
price

Net price

Net amount

VAT

Gross amount
incl. VAT

Card no:704470025992000013 ROXY-LYZA SRL VL-24-LUM

01.10 17:05 NYBORG

C00148 miles Diesel

500,00

9,69

7,752

3.876,00

969,00

4.845,00 A

05.10 17:02 NYBORG

C00840 miles Diesel

200,00

9,69

7,752

1.550,40

387,60

1.938,00 A

07.10 16:16 NYBORG

C00789 miles Diesel

500,07

9,69

7,752

3.876,54

969,14

4.845,68 A

09.10 17:13 NYBORG

C00919 miles Diesel

200,19

9,74

7,792

1.559,88

389,97

1.949,85 A

13.10 16:51 NYBORG

C00597 miles Diesel

500,00

9,79

7,832

3.916,00

979,00

4.895,00 A

15.10 16:56 NYBORG

C00667 miles Diesel

400,00

9,69

7,752

3.100,80

775,20

3.876,00 A

19.10 16:50 NYBORG

C00366 miles Diesel

300,21

9,64

7,712

2.315,22

578,80

2.894,02 A

21.10 16:51 NYBORG

C00253 miles Diesel

500,06

9,42

7,536

3.768,46

942,11

4.710,57 A
1.884,66 A

23.10 17:05 NYBORG

C00231 miles Diesel

200,07

9,42

7,536

1.507,73

376,93

28.10 23:47 NYBORG

C00656 miles Diesel

600,02

9,54

7,632

4.579,35

1.144,84

30.050,38

7.512,59

37.562,97

30.050,38

7.512,59

37.562,97

National purchases in invoice period

5.724,19 A

VAT info
VAT rate

Base VAT amount

25,00 %

30.050,38

Total VAT per VAT rate

7.512,59

Excise duties
Excise duty
NOX AFG. /MOMS
EN.AFG. DIESEL /MOMS
CO2 AFG. /MOMS

Statoil Fuel & Retail A/S

CVR: DK28142412

Total excise duties

230,12
12969,56
2047,83

PO Box 120, 0900 Kbenhavn C

Borgmester Christiansens Gade 50, Kbenhavn SV

Telefon: (+47) 70 101 101

www.statoil.dk

COUNTRY SPECIFICATION
ROXY-LYZA SRL
BLVD. TINERETULUI NR. 14
BL. S2, SC. I, ET. 2, AP. 12
240021 RAMNICU VALCEA
RUMNIEN

Date

Time

Point of sale

Reference number:

815645287

Invoice date:

31.10.2015

Customer number:
Customer VAT-no:

0005272232
RO18972664

Page

Ver.no.

Product

Quantity

Gross
per liter

Rebate
incl.
VAT

2/2

Net in local
currency

VAT in local
currency

Total in
local
currency

Amount
payable incl.
VAT

Purchases in Sverige
Card no:704470025992000013 ROXY-LYZA SRL VL-24-LUM
30.09 19:44 Ljungby

C00089 VIGNETTE U/MOMS

1,00

74,52

0,00

74,52

59,97

02.10 01:23 Kumla

C00089 VIGNETTE U/MOMS

1,00

1.175,76

0,00

1.175,76

944,77

1.250,28

0,00

1.250,28

1.004,74

International purchases

1.004,74

Purchase statistics
Card purchases

Quantity

Net

VAT

Gross amount

Total this period

DIESEL

3.900,62

VEJAFGIFT

30.050,38

7.512,59

37.562,97

1.004,74

0,00

1.004,74

105.609,31

26.402,32

132.011,63

4.591,07

0,00

4.591,07

Total year to date

DIESEL

12.980,95

VEJAFGIFT

*=Momsfri/Udland, A=Listepris, B=Pumpepris

Statoil Fuel & Retail A/S

CVR: DK28142412

PO Box 120, 0900 Kbenhavn C

Borgmester Christiansens Gade 50, Kbenhavn SV

Telefon: (+47) 70 101 101

www.statoil.dk