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Appendix 3bis A): Designation and/or change of duration of designation of the Access Responsible Party charged with off-take of the load and designation of the corresponding energy supplier (see Articles 8, 11 and 20) This document forms an integral part of the Access Contract with the reference: []

1. Designation /Change of duration of designation of the Access Responsible Party charged with off-take of the load:

[]

Name of Access Point + address of site

[]

Last month of designation of ARP

Access Point (EAN Code)

First month of designation of ARP

Table of Access Points

(month/year)

(month/year)

[]

[]

With regard to signing Appendices 9, 10 or 11, it is important to understand the term “Offtake Energy” in these Appendices as being energy taken off by the load. The Access Responsible Party specified in more detail below is designated by the Access Holder as the Access Responsible Party charged with off-take of the load for: each Access Point that is included in the Access Contract with the reference: [] each Access Point with the characteristics indicated in the table above:

and this Access Responsible Party accepts this designation. (indicate above whichever applies) The Access Holder designates himself as Access Responsible Party charged with offtake of the load (he must be listed in the register of Access Responsible Parties kept up to date by Elia). To this end, the Access Holder designates the following Access Responsible Party charged with off-take of the load (this Access Responsible Party must be listed in the register of Access Responsible Parties kept up to date by Elia). (indicate above whichever applies)

Access Contract

Date

[●]/[●] V1/2012 !! For information purposes only !!

[●] [●]


Company details of Access Responsible Party charged with off-take: Company:

[]

EIC-Code:

[]

Head office:

[]

Company reg. no.:

[]

VAT no.:

[]

Represented by:

[]

Designation of the corresponding energy supplier:

The supplier defined in more detail below is designated by the Access Holder as the corresponding supplier for each Access Point mentioned in the present Appendix.

The Access Applicant designates himself as the supplier; The Access Applicant designates the following supplier for this purpose (indicate above whichever applies) Company details of supplier company: Company:

[]

Head office:

[]

Company reg. no.:

[]

VAT no.:

[]

Represented by:

[]

Any person completing the present Appendix must provide the Grid User concerned with a copy of hereof.

2. Renewal of designation of the Access Responsible Party charged with Off-take of the load Ninety calendar days before the period of validity for designating the ARP mentioned in the present Appendix expires (to the extent that the period of validity thereof permits it), Elia will communicate, by way of information, the procedure described hereafter to the Access Holder, the ARP and the Grid User:

No later than thirty calendar days before the period of validity of the designation of the ARP expires, the Access Holder shall inform Elia of the designation of an (new) ARP, through the introduction of an Appendix type 3, 3bis or 3ter, duly completed to this end. Elia will then communicate this information to the Grid User and the current ARP(s).

Access Contract

Date

[●]/[●] V1/2012 !! For information purposes only !!

[●] [●]


If no ARP has been designated by ten calendar days before the period of validity of designation of the ARP expires, Elia will send the Access 1 Holder concerned a notice of default (by e-mail and/or fax), obliging him to conclude an ARP Contract (of which a specimen will be appended to the notice of default) and to fulfil the conditions and obligations specified therein. The notice of default will indicate that the Access Holder 2 concerned may still designate an (new) ARP for the Access Points concerned before the current period of validity of designation of the ARP expires. A copy of this notice of default will be sent to the regulator concerned and, as the case may be, the Grid User. 3

If the Access Holder concerned does not comply with the instructions in this notice of default, Elia may disconnect the Access Point(s) concerned from the date of expiry of the validity period for designating the ARP indicated in the Appendix concerned. Elia will inform the regulator concerned of such disconnection. The effectiveness of the aforementioned designations remains subordinate to the signature of ad hoc contracts and the establishment of the guarantees provided thereunder, from which the present Appendix does not depart. The signature relates to the designation or modification thereof

4

(Signature of Access Holder )

__________________

Date:

Signature of Access Responsible Party charged with off-take of the load

__________________

Date:

Signature of corresponding energy supplier

__________________

Date:

1

That is, the Access Holder designated for the period extending beyond the expiry date of the period of validity for designating the ARP or the supplier, and in the absence of such designation the Grid User himself. 2 Ditto. 3 Ditto. 4 Signature of Access Holder except for authorisation given in accordance with Appendix 13.

Access Contract

Date

[●]/[●] V1/2012 !! For information purposes only !!

[●] [●]


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