STATEMENT
on the meeting of independence criteria by a Supervisory Board member
of the Private Joint Stock Company “National Power Company “Ukrenergo” 
(hereinafter - the Company)

I, ____________________________________________________________________
(surname, name, patronymic – if available)
(born on ____ ____________ 19__, passport/ID series ____ No. ____________,                              issued  ___________________by _____________________________________________), 

hereby inform that I meet the independence criteria put forward to a member of the Supervisory Board as established by legislation of Ukraine, namely:

I.	In accordance with Article 73 of the Law of Ukraine “On Joint Stock Companies”:
1)	I am not and in the past five years have not been a member of executive body of the Company and/or its affiliated legal entities;
2)	I am not receiving and in the past three years have not received from the Company and/or its affiliated legal entities additional material remuneration exceeding 5% of annual income of such an entity for each of these years;
3)	I do not hold (directly or indirectly) 5% and more of the statutory capital of the Company and I am not either a manager or a member of executive body of the Company or an individual entrepreneur who in the past year has had substantial business relationship with the Company and/or its affiliated legal entities;
4)	I am not and/or I have not been in the previous three years a key partner, official or employee of an auditing entity that participated in the provision of mandatory audit services of the Company's financial statements and/or its affiliated legal entities;
5)	I am not and in the past three years have not been an employee of an audit firm which has provided audit services to the Company and/or its affiliated legal entities in the past three years;
6)	I am not an employee of the Company and/or its affiliated legal entities and have not been one in the past three years;    
7)	I am not a shareholder – owner of controlling interest and/or I am not a representative of a shareholder – owner of controlling interest of the Company in any civil relationship;
8)	I have not been for more than 12 years totally a member of the Supervisory Board of the Company; 
9)	I am not related to family relations with the persons specified in points 1 – 8 of part one of Article 73 of the Law of Ukraine “On Joint Stock Companies”;
10)	I meet the additional criteria established by the Charter of the Company or other internal documents of the company.
The requirements of paragraphs 1, 2 and 6 of this section shall not apply to the cases of holding the position of an independent director of the company and the relations related thereto.

II. In accordance with Article 113 of the Law of Ukraine “On State Property Management”:
1)	I am not and within the last five years have not been an official of the Company, subsidiary, branch, representation, and/or other separate unit, except as an independent member of the supervisory board;
2)	I am not and within the last three years have not been an employee of the Company, subsidiary, branch, representation, and/or other separate unit;
3)	I am not an affiliated person (as defined in the Law of Ukraine “On Joint-Stock Companies”) of Company, subsidiary, branch, representation, and/or other separate units and/or their officials;
4)	I am not receiving and within the last three years have not received any income from the Company, subsidiary, branch, representation, and/or other separate unit, except for income as a supervisory board member;
5)	I do not hold (directly or indirectly) 5% and more of the statutory capital of the Company (independently or together with affiliated persons) and do not represent the interests of such holder;
6)	I am not a civil servant or representative of the state;
7)	I am not an independent auditor of the Company, subsidiary, branch, representation, and/or other separate unit and have not held such position in the last three years preceding the appointment (election) to the supervisory board;
8)	I do not participate in audits of the Company, subsidiary, branch, representation, and/or other separate unit as an auditor working for an audit organization, and have not participated in such audits in the last three years preceding the appointment (election) to the supervisory board;
9)	I do not have and have not had within the last year substantial business relationship with the Company, subsidiary, branch, representation, and/or other separate unit directly as an individual entrepreneur or as a shareholder (participant), leader or member of the executive body of an economic entity that has or had such relations. For the purposes of this paragraph, substantial business relations are determined by the Charter or the Regulation on the supervisory board;
10)	I have not been for more than 12 years totally a member of the Supervisory Board of the Company; 
11)	I am not a close person to individuals mentioned in points 1-10 above (the term “close person” is used as defined in the Law of Ukraine “On Prevention of Corruption”).
The requirements of paragraphs 1, 2 and 4 of this section shall not apply to the cases of holding the position of an independent director of the company and the relations related thereto.

_____ _____________ 20____			     __________________
                                                                                                                  (signature)