STATE STATISTICAL REPORTING

CONFIDENTIALITY IS GUARANTEED BY THE RECEIVER OF INFORMATION

Submission of the distorted data of the state statistical reporting, untimely submission or non-presentation of such reporting attract application of measures of administrative or criminal liability according to legal acts

Respondents represent

Representation term

Form 12-ves (services)

legal entities, the separate divisions of legal entities having separate balance according to Instructions on filling of this form

in the form of the electronic document

To the main statistical city department of Minsk; to department of statistics in the area (city) of the head statistical department of area *;

The 18th after the accounting period

Form code
on OKUD

0645001

Monthly

national association "Belarusian railroad" (aggregative primary statistical data on consolidation), the Ministry of Foreign Affairs (aggregative primary statistical data on diplomatic representations and consular establishments of the Republic of Belarus abroad)

in the form of the electronic document

To National Statistical Committee

The 25th after the accounting period

Full name of the legal entity _______________________________________________________

Full name of separate division of the legal entity _____________________________

Postal address (actual) _________________________________________________________________

E-mail address (www, e-mail) _______________________________________________________________

Registration number of the respondent in the statistical register (RCBO)

Accounting Number of the Payer (ANP)

1

2

Name of indicator

Code of line,
country code

The cost of the exported services for month under report

rubles

thousand dollars of the USA

And

B

1

2

In total by the form services

10

including over the countries:

11

x

x

Name of indicator

Code of line, country code

The cost of the imported services for month under report

rubles

thousand dollars of the USA

And

B

1

2

In total by the form services

20

including over the countries:

21

x

x

Name of indicator

Code of line,
country code

Proceeds from sales of tickets

rubles

thousand dollars of the USA

And

B

1

2

In total by the form services

30

including over the countries:

31

x

x

Name of indicator

Code of line

Service export

Service import

And

B

1

2

Estimate service cost portion in total cost of service of this type in the following methods of its provision and (or) obtaining (at %, in integers):

cross-border provision (codes of types of service 0710, 1005, 1006, 1007, 1008, 1009,1031, 1032, 1099, 2120, 2200, 2310, 2320, 2400 and 2500)

41

consumption abroad (codes of types of service 1099, 2120, 2200, 2310, 2320, 2400 and 2500)

42

presence of the contractor of service (codes of types of service 0710, 1005, 1006, 1007, 1008, 1009, 1031, 1032, 1099, 2200, 2310, 2320, 2400 and 2500)

43

Estimate cost portion of the service provided and (or) received by means of information and communication technologies in total cost of service of this type (codes of types of service 1005, of 1006, of 1007, 1008 and 2120) (at %, in integers)

44

Respondent's head
or the representative on creation
and representation of primary
statistical data worker
respondent __________________________

_____________

_____________________

(position)

(signature)

(initials, surname)

___________________________________________

___ __________________ 20 __.

(contact phone number, e-mail address)

(date of creation of state
statistical reporting)