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Page 1
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11Property address
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22Customer information
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33Type of reporting
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44Information on amounts due for the reporting period
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55Information on offsetting amounts from the retroactive reduction
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66Remaining amount due for the reporting period
Formed as a sum of items 4 and 5 (the row referring to the reporting period)
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77Information about receivables or payables of the consumer for past periods
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88Total amount of payables or receivables of the consumer as of the specified date
Formed as a sum of items 6 and 7
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Page 2
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99Detailed information on forming the amount under item 7
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1010Initial data and explanations on the invoice formation for the current period
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Page 3
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1111Useful information for the consumer
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1212Payment methods
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