Exp.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

by fax at +49 / 221 / 740 94 71

Rolf Schubert + Partners
Appraiser of Real Estate
Baptiststrasse 27
D-50769 Cologne

Place of Issue, Date

Improved / Unimproved property
Free-hold flat No. _ _ in

Date of estimation

Purpose of appraisal

Object postal code / Place / local subburb

Object road / House No.

Gemarkung legal area name / Flur / Flurstueck Nr.

Land register sheet no.

Owner, name, first name

Address, telephone number.

I informed myself in the table of fees about the costs which can be expected to be due and agree to pay the fees specified therein. In addition the costs for the acquisition of necessary documents are carried by me. The following pre-payment serves the covering of the costs of the local date.

While placing my order, at the latest to the local date I transfer a pre-payment at a value of 1.000 € to the account of the expert 506 2708 with SSK Cologne, BLZ 370 501 98 (Int. Bank Account Number: DE13 3705 0198 0005 0627 08; SWIFT-BIC.: COLSDE33); VAT-ID-No: DE122816190.

The requestor will grant the expert admission to the evaluation object.

Requestor, name, Address, telephone, if necessary email address

Request authorization

Date, signature