Declaration Concerning Payment for Italy

Please complete the "Declaration Concerning Payment" and sign it on the reverse side. The original document must be sent to the following address:

Deutsche Post AG

Niederlassung Renten Service

13496 Berlin

Germany

Please note that you, as the pension beneficiary, must be the account holder or a joint account holder of the bank account. This does not prevent other persons from being authorized to operate the account.

If you are not the sole account holder, please also provide the surname, first name, relationship, and address of the account holder(s) or joint account holder(s) authorized on the account in Section 2 below.

Important Printing Notice (Duplex Printing)

The form must be printed double-sided, with the front and reverse sides on the same sheet of paper (duplex printing).