[Name and details of the institution]

[Name and details of the JST Coordinator]

[Place, date]

[Institution's reference]

Inclusion of profits in Common Equity Tier 1 (CET1) capital

Dear [Sir/Madam],

For the purpose of the submission of supervisory reporting referred to [regulatory reporting reference date], pursuant to Article 26(2) of Regulation (EU) No 575/2013 of the European Parliament and of the Council and to Decision (EU) 2015/656 of the European Central Bank (ECB/2015/4), I hereby notify the intention of [name of the institution/banking group/banking sub-group] to include in its [individual/consolidated] CET1 capital the net profits resulting from its [interim/annual] financial statements as of [balance sheet date].

The net profits to be included in CET1 capital have been calculated as follows:

(a) undistributed pre-tax profit [EUR 0] (b) taxes [EUR 0] (c) other charges imposed by the supervisor [EUR 0] (d) other foreseeable charges not included in profit and loss statement [EUR 0] (e) total charges (b + c + d) [EUR 0] (f) decided or proposed dividend [EUR 0/blank] (g) maximum dividend under internal policy [EUR 0] (h) dividend according to average pay-out ratio (last three years) [EUR 0] (i) dividend according to last year's pay-out ratio [EUR 0] (j) dividend to be deducted (max (g, h, i) if (f) is blank; (f) otherwise) [EUR 0] (k) impact of regulatory restrictions [EUR 0] (l) profit that can be included in CET1 (a – e – j + k) [EUR 0]

For the purposes of the above, I hereby declare that:

the figures above are accurate to the best of my knowledge; the profits have been verified by persons who are independent of this institution and who are responsible for the auditing of this institution's accounts, as required by Article 26(2) of Regulation (EU) No 575/2013 and by Decision (EU) 2015/656 (ECB/2015/4). In this regard, I enclose the [audit report/review report/comfort letter] from [auditor's name]; the profits have been evaluated in accordance with the principles set out in the applicable accounting framework; any foreseeable charge or dividend has been deducted from the amount of the profits, as shown above; the amount of dividends to be deducted has been estimated in accordance with Decision (EU) 2015/656 (ECB/2015/4). In particular, deductible dividends are based on a formal decision/proposal or, if such formal decision/proposal is not available, on the highest of: (i) maximum dividend according to dividend policy; (ii) dividend based on the average pay-out ratio over the last three years; (iii) dividend based on last year's pay-out ratio. If the expected dividend pay-out has been calculated by using a pay-out range instead of a fixed value, the upper end of that range has been used; the management body of [name of the institution/banking group/banking sub-group] commits to make a proposal for distributing dividends that is fully consistent with the above calculation of the net profits.

Yours sincerely,

[Name and position of authorised signatory]