TaxForm

Formular de inregistrare Power of Attorney/Agreement Power of Attorney Form 2848 Form 8821 Agreement

Le vei gsi n acest pachet

Salut, i mulumim c ai ales RT Tax s i recupereze taxele din SUA! Returnarea taxelor nu a fost niciodat mai uoar! Urmrete aceti pai:

LISTEAZ toate paginile acestui fiier

SEMNEAZ la semnul X

F O POZ sau SCANEAZ documentele de mai jos:

Formularul/formularele W-2 sau ultimul pay slip/urile (de la fiecare angajator) Copie dupa card-ul tau Social Security Copie dupa viza ta SUA din pasaport Formularul DS-2019 (doar pentru deintori de viz J-1)

NOT: Chiar dac nu ai toate documentele necesare, poi s ncepi procesul de recuperare taxe. Vom obine documentele lips pentru tine!

DEPUNE TOATE DOCUMENTELE LA RT TAX!

ncarc ONLINE pe www.rttax.com Sau trimite e-mail pe [email protected] Sau adu sau trimite la biroul de reprezentan RT Tax

AMERICAN EXPERIENCE Craiova Universitatea din Craiova, Sala 139, Str. A.I.Cuza, Nr 13 Tel.: 0733 070 002 E-mail: [email protected]

Oradea Campus Universitatea Oradea, Str. Universitatii, Nr.5, Cladirea Noua, Sala CNC I.4 Tel.: 0733 070 013 E-mail: [email protected]

RELAXEAZ TE! TU I-AI FCUT TREABA! DE RESTUL NE OCUPM NOI!

Va trimitem un e-mail cu estimarea realizata (In cazul in care nu primiti acest email va rugam sa ne contactati la [email protected] sau online pe www.rttax.com).

Procesam documentele trimise de dvs. si trimitem aplicatia la Oficiul Fiscal din S.U.A Dupa aprobarea cererii Oficiul Fiscal ne va transfera returnarea. Procesul de recuperare al taxelor din S.U.A incepe la sfarsitul anului fiscal,pe date de 1 ianuarie. RT Tax completeaza si trimite documentele necesare la Oficiul Fiscal din S.U.A in cel mai scurt timp. Dupa trimiterea documentelor,perioada de returnare depinde de Oficiul Fiscal din S.U.A In ce conditii pot intarzia Autoritatile Fiscale eliberarea returnarii:

- nu ne-ati furnizat informatii despre TOTI angajatorii dvs. - nu ne-ati furnizat ULTIMUL pay check sau DOCUMENTUL W2 de la toti angajatorii dvs. - Oficiul Fiscal din S.U.A alege sa auditeze dosarul dvs.

V RUGM S FOLOSII LITERE DIN ALFABETUL ENGLEZESC!

Prenume:

Al doilea prenume:

Nume:

Tel. fix.:

Data naterii: 19 _ _ / _ _ l / _ _ z Tel. mobil.:

Adresa de e-mail:

Numr Social Security:

Data n care ai ajuns n SUA: 2 0 _ _ a / _ _ l / _ _ z Data n care ai prsit SUA: 2 0 _ _ a / _ _ l / _ _ z

Pentru ce an(i) doreti ca RT Tax s-i recupereze taxele?

Ai mai aplicat pentru recuperarea acestor taxe la o alt companie sau individual? Da Nu

Ci angajatori ai avut: n care stat ai lucrat?

Trebuie s treci TOI ANGAJATORII (chiar dac nu ai pltit taxe la acel loc de munc) i s ne furnizezi

ULTIMUL (ULTIMELE) PAY-SLIP(URI) sau formularele W-2. Dac nu le ai, te vom ajuta s le obii.

1. Compania: 2. Compania:

Adresa: Adresa:

Tel/Fax: Tel/Fax:

E-mail: E-mail:

Da Nu Da Nu

Dac NU, doresc ca RT Tax s-l recupereze Da Nu Dac NU, doresc ca RT Tax s-l recupereze Da Nu

3. Compania:

Adresa:

Tel/Fax:

E-mail:

Da Nu

Dac NU, doresc ca RT Tax s-l recupereze Da Nu

4. Compania:

Adresa:

Tel/Fax:

E-mail:

Da Nu

Dac NU, doresc ca RT Tax s-l recupereze Da Nu

Semnnd acest formular declar c informaiile, Semntura:

oferite de mine sunt corecte i complete. Date:

Am formularul W-2 sau ultimul pay-slip de la acest loc de munc




Client notes:

RT Tax notes:Income:

Taxes paid:

Vrugmsasiguraiaiciadresadedomiciliu:NUMELE DUMNEAVOASTR:(V RUGM S FOLOII MAJUSCULE)

ADRESA POTAL:

VRUGMSALEGEIMONEDANCAREDORIISVPRIMIIRAMBURSAREA:

Vei primi rambursarea impozitului pltit n plus n LEI, n funcie de cursul de schimb valutaral bncii indicate de executor.

V rugm s sunai sau s v vizitai banca nainte de a completa mai departe. Putei ataa i o declaie de la banc, care s demonstreze detaliile contului dumneavoastr pentru transferul interanional de bani n USD.

IMPORTANT: RT TAX V VA TAXA CU 20 USD PENTRU TRANSFERUL BANCAR.RT TAX NU ESTE RESPONSABIL PENTRU COMISIOANELE ADIIONALE NCASATE DE BANCA CLIENTULUI. Va exista o tax adiional de 50 USD ncasat de banc, dac aceasta va trebui s repete transferuldatorit unor informaii furnizate incorect sau incomplet.

DETALIILE BNCII BENEFICIARECONTUL BANCAR PERSONAL (IBAN):

NUMELE COMPLET AL TITULARULUI DE CONT:

INFORMAII BANCARE:(NUMELE COMPLET AL BNCII; NUMELE FILIALEI)

(CODUL SWIFT AL BNCII / CODUL SORT)

(ADRESA BNCII: ORAUL I ARA)

Semnnd acest formular declar c toate informaiile Semntura:pe care le-am furnizat aici sunt corecte i complete.Sunt de acord cu termenii i condiiile subliniate n acest formular. Data: 2 0 _ _ / _ _ / _ _

Semntura: ____________________________ Data: 2 0 _ _ / _ _ / _ _

USD

(PRENUMELE, AL DOILEA PRENUME, NUMELE DE FAMILIE)

(STRADA, NUMRUL, APARTAMENTUL)

(JUDEUL, SATUL, COMUNA SAU ORAUL)

(CODUL POTAL I ARA)

RON

Doresc s particip n programul Work and Travel 2016 prin intermediul American Experience i s folosesc suma de ________ $ din returnarea taxelor ca plat pentru costul total al programului. V rog s virai suma de ________ reprezentnd avans din returnarea taxelor pentru a susine financiar costul total al programului ctre American Experience. n cazul n care suma recuperabil depete 250 USD v rog s i transferai printr-un virament bancar separat de ndat ce procesul de recuperare a taxelor mele s-a finalizat

2016

POWER OF ATTORNEY

.................................................................................................................., personal ID No / date of birth ................................ (the Principal) hereby authorises UAB A & Z Group, company code 302522637, office address at Laisves Al. 67, Kaunas, Lithuania, its managers and/or employees (the Agent)

to perform any and all actions required for the proper performance of the Agents obligations under the Collection Agreement executed with the Principal, i.e. including, but not limited to:

(i) to receive the cheques drawn for the benefit of the Principal and in the name of the Principal or in the name of the Agent (the Cheques) from any persons; (ii) to collect the Cheques in the bank account of the Agent; (iii) to receive on behalf of the Principal amounts transferred by third parties; (iv) to transfer the amounts received after collection of Cheques or received directly from the third parties to the Principal by a bank transfer, by issuing a cheque or in any other way if its agreed by the Principal and the Agent; (v) from the amount to be transferred to the Principal to deduct the fee payable to the Agent under the Collection Agreement and the amount of service fee payable to Torus Solution NV, under the Services Agreement executed between the Principal and Torus Solution NV; (vi) to prepare, sign, submit and receive all and any documents related to the above mentioned assignments, and to perform all and any other actions in connection with the foregoing.

The Agent shall be entitled to delegate powers granted hereunder to any third person. This Power of Attorney shall be valid for 2 (two) years from its execution. The Principal (signature): ___________________________________ Date: __________________________

Collection Agreement Place: ..................................... Date: ....................................

This Collection Services Agreement (the Agreement) is executed by and between: (1) UAB A & Z Group, company code 302522637, Laisves Al. 67, Kaunas, Lithuania (the Agent), e-mail: [email protected], and

(2) ............................................................................................................................................................., date of birth......................................... (the Principal). Hereinafter the Agent and the Principal together are referred to as the Parties and each separately as the Party. RECITALS (A) The Principal and Torus Solution NV have executed the Services Agreement, pursuant to which Torus Solution NV shall provide receivables administration services (the

Receivables) in accordance with the Services Agreement. Receivables will be refunded to the Principal in a form of cheque (cheques will be drawn in the name of the Principal or the Agent, who provides cheques collection and related services (the Cheque), as the nominee of the Principal )or by a direct bank transfer;

(B) The Parties wish to agree on the terms and conditions of the collection of the Cheque; (C) For the purposes of implementation of this Agreement, the Agent will use the personal data, bank account details and other information of the Principal submitted to the

Agent. 1. Subject matter 1.1. In accordance with the terms and conditions set in this Agreement, the Agent shall provide to the Principal cheques collection and related services (the Services) and the

Principal shall accept and remunerate for such Services. 2. Terms of Provision of Services 2.1. The Parties agree that the Agent will act and shall be indicated in all related documents as the nominee to receive the Cheque and/or other kinds of payments on behalf of

the Principal. 2.2. Once the Cheque is received by the Agent, he will submit the cheque for collection to any bank selected by the Agent. The submission shall be made not later than within

15 (fifteen) days from the receipt of the Cheque or other receivables. 2.3. The Cheque or other payments received shall be collected on the separate bank account of the Agent. The collected money and/or amounts received from the third parties

shall be accounted separately from the funds of the Agent in a separate account. The Parties agree that these amounts are owned by the Principal and are held in the account of the Agent for the benefit of the Principal in accordance with this Agreement until the transfer of the amounts due to the Principal in accordance with this Agreement. These amounts shall not be considered as the income of or as otherwise owned by the Agent and, unless agreed otherwise, the Agent shall not be entitled to use the collected money for his own needs.

2.4. If according to this agreement, the Principal does not provide required Principals personal data including bank account information for completion of the Services within 1 (one) year from the date the Collection Agreement was signed, the Agent shall deduct its service fee and (if applicable) additional bank charges under Section 2.6(ii) and shall transfer the remaining amount(s) to Torus Solution NV bank account. This shall be treated as proper and full performance of the obligations of the Agent set in the Agreement and the Agent shall not be held liable for any further claims against the amounts concerned.

2.5. The money received after collection of the Cheque or received directly from any third parties shall be refunded to the Principal after deduction of the Service Fee in accordance with Section 3.1, 3.2 hereof, and the service fee payable by the Principal to the Torus Solution NV under the Services Agreement and (if applicable) additional bank charges under Section 2.6(ii), by a bank transfer or by a bank cheque drawn in the name of the Principal or his/her nominee.

2.6. The Agent shall bear the cost of one bank transfer. However, the Agent shall not be responsible for (i) any fees charged by the Principals bank or intermediary bank; or (ii) for any additional bank charges if the bank needs to repeat the transfer because of the incorrect or incomplete information provided. Where the receivable amount is converted from one currency to another, it shall be calculated in accordance with the exchange rate applied by the respective bank valid on the day of conversion for the purposes of the bank transfer to be made to the Principals bank account. The Agent shall bear the cost of the currency conversion.

2.7. While providing the Services the Agent shall as necessary disclose that he is acting as the nominee of the Principal and the collection of the Cheque or other payments received and transfer of money is made in the name and on behalf of the Principal.

3. The Services Fees 3.1. The fee for the Services (the Service Fee) shall be a fixed amount of USD 20 (twenty) plus VAT (if applicable) for one transfer and USD 5 (five) plus VAT (if applicable) for

each cheque issued to the Principal in accordance with the terms and conditions of this Agreement. 3.2. The Service Fee shall be deducted from the amount received after collection of the Cheque or from the other payments received, prior to the transferring it to the

Principals bank account or issuing the cheque. 4. Validity of the Agreement 4.1. The Agreement shall come into force upon signing of it by both Parties and shall be valid until the proper and full performance of the obligations of the Parties set in the

Agreement. 4.2. The Agreement may be terminated by the mutual agreement of the Parties. 4.3. The Principal shall have the right to unilaterally terminate the Agreement only prior to Torus Solution NV has started implementing agreed conditions described in the

Services Agreement, by informing the Agent in accordance with Section 5.3 hereof. After Torus Solution NV activities has been started, the Agent will complete the provisions of the Services hereunder, to the extent possible, and shall have a right to make the deductions in accordance with Section 2.5 and (if applicable) Section 2.6 hereof.

5. Miscellaneous 5.1. This Agreement is executed in English. The electronic copy of the Agreement shall be provided to the Principal at his request after it is executed by the Agent. All

amendments to the Agreement shall be valid if they are in writing and signed by both Parties. 5.2. The Agreement shall be governed by the Lithuanian law, and any dispute arising from or in connection with the Agreement shall be resolved by the court of the Republic of

Lithuania. 5.3. All notices and other communication under this Agreement shall be in writing and shall be handed in person or sent by regular mail, e-mail or fax to the addresses of the

Agent provided above, and to the addresses of the Principal provided by the Torus Solution NV under the Services Agreement. Agent Principal _____________________________________ ______________________________________

POWEROFATTORNEYI, the undersigned.............................................................,

date of birth .., Social Security number ............., residing at

...................................................................

(hereinafterreferredtoasthePrincipal),herebygrantapowerofattorneytothecompany,UABPildom,its

officersand/oremployeeswithitsregisteredaddressatLaisvesAl.67,Kaunas,Lithuania(hereinafterreferredtoas

theAgent),tosign,verifyandfilealltheprincipalsfederal,state,socialsecurityandmedicare,localincomeand

othertaxreturns;examineandcopyalltheprincipalstaxreturnsandrecords;representtheprincipalbeforeany

federal,stateorlocalrevenueagencyortaxingbodyand,ingeneral,exerciseallpowerswithrespecttotaxmatters

whichtheprincipalcould,ifpresentandundernodisability.

OnthebasisofthispowerofattorneyUABPildomitsofficersand/oremployeesaregiventheauthority:

1. ToactasanagentinpreparinganddealingwiththePrincipalsincometaxreturn(s)forthetaxyears20102015.

2. TouseownpostaladdressonthePrincipalstaxreturn(s).

3. ToreceiveallcorrespondencefromtheIRSandStateTaxAuthorities.

4. TorequestfromthePrincipalsemployer(s)andtoreceivePrincipalsW2formtotheaddress:

7700 Brush Hill Rd. Suite #115, Burr Ridge, IL 60527, USA

Signedthis.......dayof....,20............

SignatureofthePrincipal:

Form 2848(Rev. July 2014) Department of the TreasuryInternal Revenue Service

Power of Attorney and Declaration of Representative

a Information about Form 2848 and its instructions is at www.irs.gov/form2848.

OMB No. 1545-0150

For IRS Use Only

Received by:

Name

Telephone

Function

Date / /

Part I Power of AttorneyCaution: A separate Form 2848 must be completed for each taxpayer. Form 2848 will not be honored for any purpose other than representation before the IRS.

1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7.

Taxpayer name and address Taxpayer identification number(s)

Daytime telephone number Plan number (if applicable)

hereby appoints the following representative(s) as attorney(s)-in-fact:

2 Representative(s) must sign and date this form on page 2, Part II.

Name and address

Check if to be sent copies of notices and communications

CAF No.

PTIN

Telephone No.

Fax No. Check if new: Address Telephone No. Fax No.

Name and address

Check if to be sent copies of notices and communications

CAF No.

PTIN

Telephone No.


Name and address

(Note. IRS sends notices and communications to only two representatives.)

CAF No.

PTIN

Telephone No.


Name and address

(Note. IRS sends notices and communications to only two representatives.)

CAF No.

PTIN

Telephone No.


to represent the taxpayer before the Internal Revenue Service and perform the following acts:

3 Acts authorized (you are required to complete this line 3). With the exception of the acts described in line 5b, I authorize my representative(s) to receive and inspect my confidential tax information and to perform acts that I can perform with respect to the tax matters described below. For example, my representative(s)shall have the authority to sign any agreements, consents, or similar documents (see instructions for line 5a for authorizing a representative to sign a return).

Description of Matter (Income, Employment, Payroll, Excise, Estate, Gift, Whistleblower, Practitioner Discipline, PLR, FOIA, Civil Penalty, Sec. 5000A Shared Responsibility

Payment, Sec. 4980H Shared Responsibility Payment, etc.) (see instructions)

Tax Form Number(1040, 941, 720, etc.) (if applicable)

Year(s) or Period(s) (if applicable) (see instructions)

4 Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded on CAF,check this box. See the instructions for Line 4. Specific Use Not Recorded on CAF . . . . . . . . . . . . . . . a

5a Additional acts authorized. In addition to the acts listed on line 3 above, I authorize my representative(s) to perform the following acts (see instructions for line 5a for more information):

Authorize disclosure to third parties; Substitute or add representative(s); Sign a return;

Other acts authorized:

For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Cat. No. 11980J Form 2848 (Rev. 7-2014)

Individual Income Tax 1040EZ, 1040NR-EZ, 1040NR, 4852

FICA Tax 843, 8316

State Income Tax

This Power of Attorney is being filedpursuant to Regulations section 1-6012-1(a)(5) by reason of my continuous absence from the United States.

In addition, the representative is authorized to make, execute and file form 4506-T and specific claimfor refund on forms 843 and 8316.

Form 2848 (Rev. 7-2014) Page 2b Specific acts not authorized. My representative(s) is (are) not authorized to endorse or otherwise negotiate any check (including directing or

accepting payment by any means, electronic or otherwise, into an account owned or controlled by the representative(s) or any firm or other entity with whom the representative(s) is (are) associated) issued by the government in respect of a federal tax liability.

List any specific deletions to the acts otherwise authorized in this power of attorney (see instructions for line 5b):

6 Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically revokes all earlier power(s) ofattorney on file with the Internal Revenue Service for the same matters and years or periods covered by this document. If you do not wantto revoke a prior power of attorney, check here . . . . . . . . . . . . . . . . . . . . . . . . . . a

YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT.

7 Signature of taxpayer. If a tax matter concerns a year in which a joint return was filed, each spouse must file a separate power of attorneyeven if they are appointing the same representative(s). If signed by a corporate officer, partner, guardian, tax matters partner, executor,receiver, administrator, or trustee on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer. a IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER.

Signature

Print Name

Date Title (if applicable)

Print name of taxpayer from line 1 if other than individual Part II Declaration of Representative

Under penalties of perjury, by my signature below I declare that:

I am not currently suspended or disbarred from practice before the Internal Revenue Service;

I am subject to regulations contained in Circular 230 (31 CFR, Subtitle A, Part 10), as amended, governing practice before the Internal Revenue Service;

I am authorized to represent the taxpayer identified in Part I for the matter(s) specified there; and

I am one of the following:

a Attorneya member in good standing of the bar of the highest court of the jurisdiction shown below.

b Certified Public Accountantduly qualified to practice as a certified public accountant in the jurisdiction shown below.c Enrolled Agentenrolled as an agent by the Internal Revenue Service per the requirements of Circular 230.d Officera bona fide officer of the taxpayer organization.e Full-Time Employeea full-time employee of the taxpayer.f Family Membera member of the taxpayers immediate family (for example, spouse, parent, child, grandparent, grandchild, step-parent, step-

child, brother, or sister).

g Enrolled Actuaryenrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the authority to practice beforethe Internal Revenue Service is limited by section 10.3(d) of Circular 230).

h Unenrolled Return PreparerYour authority to practice before the Internal Revenue Service is limited. You must have been eligible to sign thereturn under examination and have prepared and signed the return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled return preparers in the instructions (PTIN required for designation h).

i Registered Tax Return Preparerregistered as a tax return preparer under the requirements of section 10.4 of Circular 230. Your authority to practice before the Internal Revenue Service is limited. You must have been eligible to sign the return under examination and have prepared and signed the return. See Notice 2011-6 and Special rules for registered tax return preparers and unenrolled return preparers in the instructions (PTIN required for designation i).

k Student Attorney or CPAreceives permission to represent taxpayers before the IRS by virtue of his/her status as a law, business, or accounting student working in an LITC or STCP. See instructions for Part II for additional information and requirements.

r Enrolled Retirement Plan Agentenrolled as a retirement plan agent under the requirements of Circular 230 (the authority to practice before the Internal Revenue Service is limited by section 10.3(e)). a IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THEPOWER OF ATTORNEY. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN PART I, LINE 2. See the instructions forPart II.

Note. For designations d-f, enter your title, position, or relationship to the taxpayer in the "Licensing jurisdiction" column. See the instructions for Part II for more information.

DesignationInsert aboveletter (ar)

Licensing jurisdiction (state) or other

licensing authority (if applicable)

Bar, license, certification, registration, or enrollment

number (if applicable).See instructions for Part II for

more information.

Signature Date

Form 2848 (Rev. 7-2014)

Form 8821 (Rev. March 2015)

Department of the Treasury Internal Revenue Service

Tax Information Authorization a Information about Form 8821 and its instructions is at www.irs.gov/form8821.

a Do not sign this form unless all applicable lines have been completed. a Do not use Form 8821 to request copies of your tax returns

or to authorize someone to represent you.

OMB No. 1545-1165

For IRS Use Only Received by:

Name

Telephone

Function

Date

1 Taxpayer information. Taxpayer must sign and date this form on line 7. Taxpayer name and address Taxpayer identification number(s)

Daytime telephone number Plan number (if applicable)

2 Appointee. If you wish to name more than one appointee, attach a list to this form. Check here if a list of additional appointees is attached a

Name and address CAF No. PTIN Telephone No. Fax No. Check if new: Address Telephone No. Fax No.

3 Tax Information. Appointee is authorized to inspect and/or receive confidential tax information for the type of tax, forms, periods, and specific matters you list below. See the line 3 instructions.

(a) Type of Tax Information (Income,

Employment, Payroll, Excise, Estate, Gift, Civil Penalty, Sec. 4980H Payments, etc.)

(b) Tax Form Number

(1040, 941, 720, etc.)

(c) Year(s) or Period(s)

(d) Specific Tax Matters

4 Specific use not recorded on Centralized Authorization File (CAF). If the tax information authorization is for a specific use not recorded on CAF, check this box. See the instructions. If you check this box, skip lines 5 and 6 . . . . . . a

5 Disclosure of tax information (you must check a box on line 5a or 5b unless the box on line 4 is checked): a If you want copies of tax information, notices, and other written communications sent to the appointee on an ongoing

basis, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a

Note. Appointees will no longer receive forms, publications, and other related materials with the notices.b If you do not want any copies of notices or communications sent to your appointee, check this box . . . . . . . a

6 Retention/revocation of prior tax information authorizations. If the line 4 box is checked, skip this line. If the line 4 box is not checked, the IRS will automatically revoke all prior Tax Information Authorizations on file unless you check the line 6 box and attach a copy of the Tax Information Authorization(s) that you want to retain. . . . . . . . . . . . . a

To revoke a prior tax information authorization(s) without submitting a new authorization, see the line 6 instructions.

7 Signature of taxpayer. If signed by a corporate officer, partner, guardian, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute this form with respect to the tax matters and tax periods shown on line 3 above.

a IF NOT COMPLETE, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.

a DO NOT SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE.

Signature Date

Print Name Title (if applicable)

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11596P Form 8821 (Rev. 3-2015)

Individual Income Tax 1040EZ, 1040NR-EZ, 1040NR, 4852

FICA Tax 843, 8316

State Income Tax

ThisServicesAgreement(theAgreement)isexecutedbyandbetween: Date:...............................(1) TorusSolutionNV(dbaRTTax),companycode126057,representedbythepersondullyauthorizedunderexistinglegislation(theServiceProvider);and(2) ....................................................................................................,dateofbirth.........................................(theClient).

HereinaftertheServiceProviderandtheClienttogetherarereferredtoasthePartiesandeachseparatelyastheParty.RECITALS

(A) TheServiceProviderprovidestaxrefundandrelatedservicesandtheClientwishestorecoverthepersonalincometaxpaidduetoworkabroadoronothergrounds.(B) ThePartieswishtoagreeonthetermsandconditionsoftaxrefund.1. Subjectmatter1.1. InaccordancewiththetermsandconditionssetinthisAgreement,theServiceProvidershallprovidetotheClienttaxrefundandrelatedservices,i.e.shalldrawupthedocuments

necessaryfortherefundofthetaxespaidbytheClient intheUnitedStatesofAmerica,UnitedKingdom,Ireland,theNetherlands,Germany,Norway,Canada,NewZealand,Australiaorother jurisdictionandshallpresent them to thecorresponding taxauthoritiesorothercompetent institutions (theServices),and theClient shallacceptandremunerateforsuchServices.

1.2. By thisAgreement theClientauthorises the ServiceProvider toprepare, signand file tax returnsand to receiveall correspondence, including tax refund cheques, from taxauthorities.ServiceProviderwillasnecessarydisclosethatheisactingasthenomineeoftheClientandalltheactionsaremadeinthenameandonbehalfoftheClient.

1.3. TaxeswillberefundedtotheClientbyabanktransferoftherefundedamounttothebankaccountorbyabankchequedrawninthenameofthenomineeindicatedbytheClient.TheTaxRefundChequeshallbecollectedandthetaxrefundamountshallbetransferredtotheClientbytheCollectionServicesProvider inaccordancewiththetermsandconditionssetintheCollectionAgreementexecutedbetweentheClientandtheCollectionServicesProvider.

1.4. The finalamountof the taxes tobe refunded shallbeestablishedbya competent institutionof the foreigncountry.Theamountscalculatedby theServiceProviderare forinformationpurposesonlyanddonotentitletheClienttoclaimthepreliminarilycalculatedamount.

2. TermsofProvisionofServices2.1. TheServiceProviderherebyundertakes:

2.1.1. toprovidetheClientinformationonthedocumentsthattheClientneedstosubmittotheServiceProviderforthepurposesoffilingforthetaxrefund;2.1.2. tocollect,completeandsignalltherequiredforms,requestsandotherrelateddocumentsonbehalfoftheClient;2.1.3. tosubmittherequireddocumentstotherespectivetaxauthoritiesorothercompetentinstitutionsthatareresponsiblefortaxrefunds;2.1.4. toinformtheClientabouttheprocessofthetaxrefundandotherrelatedmattersattheClientsrequest;2.1.5. totransfertheTaxRefundChequetotheCollectionServicesProviderforcollectionundertheCollectionAgreementexecutedbetweentheClientandtheCollection

ServicesProviderortoinstructthetaxauthoritytotransferthetaxrefundamounttotheCollectionServicesProviderforsubsequenttransferoftaxrefundamounttotheClient.

2.2. TheClientherebyundertakes:2.2.1. toprovidetotheServiceProvidercomplete,trueandaccurateinformationanddocuments(originalsandcopies)requiredforthecompletionofthetaxrefund.The

ClientisentitledtoprovidetheinformationeitherbyfillinginpaperformsprovidedbyServicesProviderorbyfillingintheonlineinformationformavailableattheServiceProvidersinternetsite;

2.2.2. tofillinandsignanyformsandotherdocumentsrequiredforthecompletionofthetaxrefund;2.2.3. toinformtheServiceProviderimmediatelyandinallcasesnotlaterthanwithin5(five)days,iftheforeigntaxorotherauthoritytransferstherefundedamountor

apartthereoforsendstheTaxRefundChequeforthefullrefundamountorapartthereofdirectlytotheClient;2.2.4. duringthevaliditytermofthisAgreementtoabstainfromexecutingtaxrefundservicesagreementswithotherserviceproviders;2.2.5. toinformtheServiceProviderofthenewemploymentorselfemploymentinaforeigncountry;2.2.6. toinformtheServiceProviderofanychangesintheClientscontactdetailsoraboutanyotherchangesthatmayhaveimpacttothetaxrefund.Theinformationcan

beupdatedontheinternetsiteoftheServiceProvideroremailed;2.2.7. topaytheServiceProvidertheServiceFeeassetoutinSection3hereof;2.2.8. toconsentthatServiceProvidercanshareandstoreClient'sdata,includingSSNandemploymentandtaxdataandtoconsentthattaxreturninformationmightbe

disclosedtoataxreturnpreparerlocatedoutsidetheUnitedStates,includingpersonallyidentifiableinformationsuchasyourSocialSecurityNumber(SSN).ThisconsentisgivenaccordingwithU.S.TreasuryReg.Section301.72163andRev.Proc.201314.

3. TheServicesFees3.1. ThefeefortheServices(theServiceFee)forrefundingtaxesforeachtaxyearshallbe:

3.1.1. FortheREGULARUSAtaxrefund(FederalandState),ifthetaxrefundamountisbetweenUSD0200,theservicefeeshallbeUSD50;USD201600,theservicefeeshallbeUSD70;USD601800,theservicefeeshallbeUSD80;USD801andmore,theservicefeeshallbe10%fromtherefundedamount.

3.1.2. AdditionalFeesappliesfortheFast49USDandfortheExpress99USDUSAtaxrefund.FastandExpressisavailableforFederalandStatetaxrefundonly.3.1.3. USAtaxrefund(SocialSecurityandMedicare):theservicefeeshallbe10%fromtherefundedamount,withafixedminimumofUSD90;

3.2. Theadditionalfees:FortheretrievalofthelostormissingdocumentsshallbeforW2(USA)USD15.ForfillingtheUSAamendedtaxreturn(Form1040X)thefeeis50USD.3.3. TheClientshallalsocompensatethefeesandcostsincurredbytheServiceProviderinthetaxrefundprocessthatcouldnotbeforeseenatthemomentoftheexecutionofthis

AgreementaslistedinthepricelistoftheServiceProvider.3.4. TheamountofthepayableVAT(ifapplicable)shallbeaddedtoallamountsindicatedinSections3.13.3hereof.ThefeesestablishedinSections3.13.2maybechangedbythe

ServiceProviderunilaterallyandshallbeapplicabletoanyrequestoftheClienttoprovidetheServicessubmittedaftertheClienthasreceivednoticeonthechangeoffees.3.5. TheServiceFeeshallbedeductedfromtheamountreceivedafterthetaxrefundpriortothetransferringittotheClientsaccount.4. Liability4.1. IftheClientterminatestheAgreementfortheotherreasonsthanfailurebytheServiceProvidertoperformitsobligationsafterthefilingforthetaxrefundisdoneorincaseof

breachofobligationssetoutinSection2.2.4hereof,theClientshallpaythefineofUSD100andshallcoverallexpensesoftheServiceProviderincurredduetotheterminationoftheAgreement,notcoveredbythefine.

4.2. TheServiceProvidershallnotbeliablefor:thedelaysinrefundingtaxesifthedelayiscausedbytheforeigntaxorothercompetentinstitutions;thefailuretorefundtaxes,forthetaxliabilityorforanyothernegativeconsequences,whichoccurredduetofalse,inaccurateorincompleteinformationprovidedbytheClientorduetoClientspriorfinancialcommitments to any foreign tax or other institutions; the negative consequences incurred by the Client due to the changes in the applicable laws, rules, regulations orproceduresapplicableforthetaxrefund;additionalbankcharges, ifthebankneedstorepeatthetransferbecauseoftheincorrectornotfull informationprovided;andanyfeeschargedbytheClientsorintermediarybank.

5. ValidityoftheAgreement5.1. TheAgreement shall come into forceupon signingof itbybothParties and shallbe validuntil theproper and fullperformanceof theobligationsof theParties set in the

Agreement.TheAgreementmaybeterminatedbythemutualagreementoftheParties.TheClientshallhavetherighttounilaterallyterminatetheAgreementpriortothefilingfortaxrefundbyinformingtheServiceProviderinaccordancewithSection6.1hereof.

6. Miscellaneous6.1. Alladditions,amendmentsandannexestotheAgreementshallbevalidiftheyareexecutedinwritingandsignedbybothPartieswithoutprejudicetoSections3.13.4hereof.The

electroniccopyof theAgreementshallbeprovided to thePrincipalathisrequestafter it isexecutedby theAgent.Thedisputesarisingbetween thePartiesregarding thisAgreementorduringtheperformanceofthisAgreementaresettledbywayofnegotiations.Incaseoffailuretocometoanagreement,thedisputesshallbefinallysettledbythecompetentcourt.AllnoticesandothercommunicationunderthisAgreementshallbeinwritingandshallbehandedinpersonorsentbyregularmail,emailorfax.

Client___________________________

03-04-05-06.pdf03 Power of Attorney USA04 FORM 2848 a405 FORM 8821 a406 Agreement_Client_torus_USA

Text1poweofattusaeng: X

agency_USA: AMERICAN EXPERIENCEfn: mn: ln: Tel: dob1: dob2: dob3: Radio Button1: 3

E-mail: ssn1: ssn2: ssn3: ssn4: ssn5: ssn6: ssn7: ssn8: ssn9: arrival1: arrival2: arrival3: departure1: departure2: departure3: taxyear: radiobutton_another:

employer: state: company1: company22: acompany1: acompany22: acompany2: acompany23: tcompany1: tcompany22: e-mailcompany1: e-mailcompany2: radiobutton_company1a:

radiobutton_company2a:

radiobutton_company1b:


company33: acompany33: acompany34: tcompany33: e-mailcompany33: radiobutton_company3a:


company44: acompany44: acompany45: tcompany44: e-mailcompany44: radiobutton_company4a:

clientnotes: taxnotes: radiobutton_company4b:

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BodyRow2[0]: p1-t23[0]: 2015, 2014, 2013, 2012p1-t23[0]_hghgnfhy: 2015, 2014, 2013, 2012

BodyRow3[0]: p1-t27[0]: 2015, 2014, 2013, 2012p1-t27[0]_yrrtdvbfbfh: 2015, 2014, 2013, 2012

Text12848usaeng: 0: X1: X

Text12848xxxfield: 1: 0: X0_fgrjrkkfig: X

Group1:

Text5: 0: 1: 2: 3: 4: 5: 6: 7: 8: 12: 2: 1:

zenklasXraudonasparasui: X

Xsign_jfjfttnnfkdk: X

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