(ii) The Par Value of the Policy shall be reduced to an amount equal to the Remaining Par Value, specified below in item (b), effective as of the date of this Proof. (a) Amount in Reais allocable to works in the Minimum Exploration Program R$[enter the Par Value] (b) Remaining Par Value R$[enter the Par Value] This Proof was effectively signed by the undersigned on [enter the date in the format month/day/year]. NATIONAL AGENCY OF PETROLEUM, NATURAL GAS AND BIOFUELS ___________________________ [signature] Name: [enter the name] Title: [enter the title] Document III Form of Default Notice and Claim for Indemnification – Policy No. [enter the number of the policy] Rio de Janeiro -RJ ([enter the date of the payment order in the format month/day/year]) [FORM TO BE PRESENTED BY ANP IN CASE OF WITHDRAWAL DO NOT FILL – OUT] In cash The undersigned, duly authorized to sign this Proof on behalf of ANP, hereby certify that (i) the Agreement was terminated without compliance with the Minimum Exploration Program or (ii) the Minimum Exploration Program was not complied with by the Contracted Parties as of [enter the initial date of failure to perform the obligations, in the format month/day/year]. We request payment of the par value of [enter the amount in words] Reais (R$[enter the Par Value]) to the NATIONAL AGENCY OF PETROLEUM, NATURAL GAS AND BIOFUELS. Withdrawal according to POLICY No. [enter the number of the policy] issued by [Name of the Insurance Company].
(ii) The Par Value of the Policy shall be reduced to an amount equal to the Remaining Par Value, specified below in item (b), effective as of the date of this Proof. (a) Amount in Reais allocable to works in the Minimum Exploration Program R$[enter the Par Value] (b) Remaining Par Value R$[enter the Par Value] This Proof was effectively signed by the undersigned on [enter the date in the format month/day/year]. NATIONAL AGENCY OF PETROLEUM, NATURAL GAS AND BIOFUELS ___________________________ [signature] Name: [enter the name] Title: [enter the title] Document III – Form of Default Notice and Claim for Indemnification Policy No. [enter the number of the policy] Rio de Janeiro -RJ ([enter the date of the payment order in the format month/day/year]) [FORM TO BE PRESENTED BY ANP IN CASE OF WITHDRAWAL – DO NOT FILL OUT] In cash The undersigned, duly authorized to sign this Proof on behalf of ANP, hereby certify that (i) the Agreement was terminated without compliance with the Minimum Exploration Program or (ii) the Minimum Exploration Program was not complied with by the Contracted Parties as of [enter the initial date of failure to perform the obligations, in the format month/day/year]. We request payment of the par value of [enter the amount in words] Reais (R$[enter the Par Value]) to the NATIONAL AGENCY OF PETROLEUM, NATURAL GAS AND BIOFUELS. Withdrawal according to POLICY No. [enter the number of the policy] issued by [Name of the Insurance Company].
preedital_R14_27062017_ingles.docx