First name(s) of the insider

Surname(s) of the insider

Birth surname(s) of the insider (if different)

Professional telephone number(s) (work direct telephone line and work mobile numbers)

Company name and address

Function and reason for being insider

Obtained (the date and time at which a person obtained access to inside information)

Ceased (the date and time at which a person ceased to have access to inside information)

National Identification Number (if applicable)

Or otherwise date of birth

Personal full home address (street name; street number; city; post/zip code; country)

(If available at the time of the request by the competent authority)

Personal telephone numbers (home and personal mobile telephone numbers)

(If available at the time of the request by the competent authority)

[Text]

[Text]

[Text]

[Numbers (no space)]

[Address of issuer or third party of insider]

[Text describing role, function and reason for being on this list]

[yyyy-mm-dd, hh:mm UTC]

[yyyy-mm-dd, hh:mm UTC]

[Number and/or text or yyyy-mm-dd for the date of birth]

[Text: detailed personal address of the insider

[Numbers (no space)]