1-Customer Registration FormSHELL CUSTOMER REGISTRATION FORM FOR SHELL E-BOXESECOTAX and French, Spanish, Portugal and Liefkenshoek tunnel e-Toll SystemCountry code :050102To order your e-boxes for Shell InterRoute Plus, please :03- Complete this Customer Registration Form and the e-Boxes Order04- Complete and scan the mandate05- Scan (pdf format) the certificate of incorporation of the company06- Scan (pdf format) the vehicle registration document of vehicles you want to order e-boxes07For more information on documents to be collected to activate ITR+ e-box, please read the tab "Documents collection".08Send it back via email :09Sign, date and add your company stamp to the Appendix and send it back to us :1011If you need assistance, please contact us at the following number : or by e-mail:1213Company Name (legal entity)euroShell Customer nr14(8 digits)15VAT registration nror EORI number16Type of customer17Delivery address for e-boxes181 address per euroShell Card Customer number19ZIP CODECITY20COUNTRY (Use the drop down menu)21Title of contact Person (Use the drop down menu)Position (of contact person)22First Name (of contact person)Last Name (of contact person)23Office Phone number (without country code and area code)24e-mail address of the contact person25Average monthly spend on French Motorway TollsGBPOREURO2627This is my first order for InterRoute Plus e-toll box with Shell28This is NOT my first order for InterRoute Plus e-toll box with Shell293032Company Stamp :Date :01/02/1433Signature :34Signee Name :35363738394041Vehicle Country CodeTitle42ALBANIAALM43ANDORRAADMME44AUSTRIAAT45BLARUSBY46BELGIUMBE47BOSNIABA48BULGARIABG49CROATIAHR50CYPRUSCYCZECH REPUBLICCZDENMARKDKESTONIAEEFINLANDFIFRANCEFRGERMANYDEGREECEGRHUNGARYHUIRELANDIEITALYITLATVIALVLITUANIALTLUXEMBURGLUMACDOINEMKMOLDOVIAMDNETHERLANDSNLNORWAYNOPOLANDPLPORTUGALPTROMANIARORUSSIARUSERBIARSSLOVAKIASKSLOVENIASISPAINESSWEDENSESWITZERLANDCHTURKEYTRUKRANIAUAUNITED KINGDOMGB

&C&9 Registered in England and WalesCompany Registration. Number: 3625633Registered office: Shell Centre, London, SE1 7NABy signing this document, you recognize that you read, understood and accepted the Appendix Shell InterRoute joined to the present document or consultable on our website www.euroshell.com. In order for us to send you the e-boxes, you'll need to return to the Shell address written on top of this document the Appendix signed and stamped.12

2-e-Boxes OrderSHELL CUSTOMER REGISTRATION FORM FOR SHELL E-BOXESECOTAX and French, Spanish, Portugal and Liefkenshoek tunnel e-Toll SystemNr of badgesContract informationRedevable informationCard informationVehicle informationDelivery AddressRenting Company informationMandatoryMandatoryMandatoryIgnoreAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledAutomatically filledMandatoryMandatoryMandatoryMandatoryMandatoryOptionalMandatoryMandatoryMandatoryMandatoryMandatoryMandatoryMandatoryOptional : have to be filled if the badges have to be delivered to another addressOptional (Mandatory if Owner of the vehicle = 'R')MandatoryUrgent Order (only if necessary, can be extra fees)Offer codeType of EquipementOrdering countryVehicle CountryVehicle License PlateMin Number of Axles TruckMin Number of Axles TrailerVehicle Registration Date (dd/MM/yyyy)Vehicle EmissionEEVGross Vehicle Weight RatingAuthorized Gross Vehicle WeightEuropean Vehicle CategoryVehicle TypeOwner of the vehicleDelivery ContactTitleDelivery Contact LastNameDelivery Contact FirstNameDelivery ContactStreetDelivery ContactAddres ComplementDelivery ContactZIPDelivery ContactCityDelivery ContactCountryRenting Company NameRenting Company SteetZip Code Renting CompanyCity Renting CompanyCountry Renting CompanyVAT ID Renting CompanySIRET number Renting CompanyEORI number Renting CompanyUse the drop down menu.Customer No Siras account number 10 digitsCompany Name40 digitsCustomer Address Streetname38 digitsCustomer Address ComplementCustomer ZIP CodeCustomer CityCustomer CountryEmail For Internet Account CreationContact TitleContact FirstNameContact LastNameCustomer VAT IDSIRET numberEORI numberCard NumberUse the drop down menu.For further information, please refer below to the table named "Vehicle category"As indicated on the vehicle certificate (with or without spaces and or dash)Our advice is to indicate 2 by default. This data will be used for the set up of the badge.Our advice is to indicate 3 by default. This data will be used for the set up of the badge.Exact date on the vehicle certificate or leave it blankUse the drop down menuUse the drop down menuField F2 of the vehicle certificate or field F1 if F2 is blankField F3 of the vehicle certificate. If blank, please indicate the same weight than in field "Gross Vehicle Weight Rating"Use the drop down menu. For further information, please refer below to the table named "Vehicle category"Use the drop down menu :

HGV = TruckLGV = Tis VL onlyUse the drop down menu :

C = You are the ownerR = Vehicle is rentedUse the drop down menuUse the drop down menuUse the drop down menu1ECOTAX + TISPL + ITR05000000000000BAA78-J-75123Euro 5No2010020100N3HGVCTISPLAL2ECOTAX + TISPL + ITR05000000000000BAT64-T-68823Euro 5No1800018000N3HGVCInterRouteAD3ECOTAX + TISPL + ITR05000000000000BAA05-T-73523Euro 5No1800018000N3HGVCTISVLAT4ECOTAX + TISPL + ITR05000000000000BA403-J-47823Euro 5No1800018000N3HGVCECOTAX + TISPLBA5ECOTAX + TISPL + ITR05000000000000BAO28-T-35223Euro 5No1800018000N3HGVCECOTAX + TISPL + ITRBE6ECOTAX + TISPL + ITR05000000000000BA943-T-37423Euro 5No1900019000N3HGVCBG7ECOTAX + TISPL + ITR05000000000000BAO28-T-35323Euro 5No1800018000N3HGVCBY8ECOTAX + TISPL + ITR05000000000000BAE09-T-01123Euro 5No1800018000N3HGVCCH9ECOTAX + TISPL + ITR05000000000000BAT42-M-63823Euro 5No1800018000N3HGVCCY10ECOTAX + TISPL + ITR05000000000000BAJ81-O-19623Euro 5No1800018000N3HGVCCZ11ECOTAX + TISPL + ITR05000000000000BAA03-K-88423Euro 5No1800018000N3HGVCDE12ECOTAX + TISPL + ITR05000000000000BAM81-J-16823Euro 5Yes1800018000N3HGVCDK13ECOTAX + TISPL + ITR05000000000000BAK67-E-00423Euro 5No1800018000N3HGVCEE140000000000000ES150000000000000FI160000000000000FR170000000000000GB180000000000000GR190000000000000HR200000000000000HU210000000000000IE220000000000000IT230000000000000LT240000000000000LU250000000000000LV260000000000000MD270000000000000MK280000000000000NL290000000000000NO300000000000000PL310000000000000PT320000000000000RO330000000000000RS340000000000000RU350000000000000SE360000000000000SI370000000000000SK380000000000000TR390000000000000UA40000000000000041000000000000042000000000000043000000000000044000000000000045000000000000046000000000000047000000000000048000000000000049000000000000050000000000000051000000000000052000000000000053000000000000054000000000000055000000000000056000000000000057000000000000058000000000000059000000000000060000000000000061000000000000062000000000000063000000000000064000000000000065000000000000066000000000000067000000000000068000000000000069000000000000070000000000000071000000000000072000000000000073000000000000074000000000000075000000000000076000000000000077000000000000078000000000000079000000000000080000000000000081000000000000082000000000000083000000000000084000000000000085000000000000086000000000000087000000000000088000000000000089000000000000090000000000000091000000000000092000000000000093000000000000094000000000000095000000000000096000000000000097000000000000098000000000000099000000000000010000000000000001010000000000000102000000000000010300000000000001040000000000000105000000000000010600000000000001070000000000000108000000000000010900000000000001100000000000000111000000000000011200000000000001130000000000000114000000000000011500000000000001160000000000000117000000000000011800000000000001190000000000000120000000000000012100000000000001220000000000000123000000000000012400000000000001250000000000000126000000000000012700000000000001280000000000000129000000000000013000000000000001310000000000000132000000000000013300000000000001340000000000000135000000000000013600000000000001370000000000000138000000000000013900000000000001400000000000000141000000000000014200000000000001430000000000000144000000000000014500000000000001460000000000000147000000000000014800000000000001490000000000000150000000000000015100000000000001520000000000000153000000000000015400000000000001550000000000000156000000000000015700000000000001580000000000000159000000000000016000000000000001610000000000000162000000000000016300000000000001640000000000000165000000000000016600000000000001670000000000000168000000000000016900000000000001700000000000000171000000000000017200000000000001730000000000000174000000000000017500000000000001760000000000000177000000000000017800000000000001790000000000000180000000000000018100000000000001820000000000000183000000000000018400000000000001850000000000000186000000000000018700000000000001880000000000000189000000000000019000000000000001910000000000000192000000000000019300000000000001940000000000000195000000000000019600000000000001970000000000000198000000000000019900000000000002000000000000000

3-MandateTAXE POIDS LOURDSMANDAT POUR LA DECLARATION DU VEHICULE ET LE PAIEMENT DE LA TAXEEntreprise (raison sociale, adresse) :Je soussign (NOM, Prnom) :Agissant en qualit de :0dument habilit(e) aux fins des prsentesDonne par la prsente, mandat AXXES SAS situe Tour Oxygne, 10-12 bd Vivier Merle, 69393 LYON CEDEX 03 France, agissant en qualit de Socit Habilit de Tlpage

Pour dclarer mon (mes) vhicule(s) lenregistrement pour mon compte et me dsigner comme redevable enregistr ainsi que pour acquitter la taxe due au titre de la taxe poids lourds en mon nom et pour mon compte.

Jatteste avoir fourni AXXES SAS, des pices justificatives valides afin de procder lenregistrement de mon (mes) vhicule(s). Ainsi je me porte garant de lexactitude et de la vracit des dites pices au regard de la rglementation applicable.

Je dclare ne pas tre li contractuellement auprs dune socit tierce pour les services cits ci-dessus, ou, le cas chant, avoir effectu toutes les oprations de rsiliation pour tout autre contrat dabonnement contract pour ces services auprs dune socit tierce.

Je souhaite recevoir les dtails de liquidation et donne, par la prsente, mandat Axxs pour solliciter en mon nom et pour mon compte les dtails de liquidation.Liste des vhicules concerns par le prsent mandatQualit du signataire (ou de la socit reprsente par le signataire) au regard du (des) vhicule(s)Genre NationalN IMMATRICULATIONPAYS DIMMATRICULATIONPropri-taireLoca-taireSous-locataireUtilisa-teur1NDA78-J-7510X02NDT64-T-6880X03NDA05-T-7350X04ND403-J-4780X05NDO28-T-3520X06ND943-T-3740X07NDO28-T-3530X08NDE09-T-0110X09NDT42-M-6380X010NDJ81-O-1960X011NDA03-K-8840X012NDM81-J-1680X013NDK67-E-0040X014ND0015ND00Fait , le01/02/14Faire prcder la signature de la mention Bon pour mandat, et apposer le cachet de lentrepriseAxxs SAS au capital de 7.500.000,00 Euros Tour oxygne 10-12 Bd Vivier Merle 69393 LYON CEDEX 03 RCS Lyon 482 930 385 N TVA : FR40482930385For information only, do not fill in the English versionHEAVY GOOD VEHICLES TAXMANDATE FOR THE REGISTRATION OF VEHICLES AND PAYMENT OF THE TAXCompany name and address:I the undersigned [Last name, First name] :Acting as :duly authorized for the purpose of this mandateGrants by this letter, mandate to AXXES SAS located Tour Oxygne, 10-12 bd Vivier Merle, 69393 LYON CEDEX 03 France, acting as SHT (Socit Habilit de Tlpage Approved Electronic Toll Company)

To declare my vehicle(s) for registration on my behalf and nominate me as the liable registered person as well as paying the tax applicable to the heavy good vehicles in my name and for my account.

I hereby confirm that I have given to AXXES SAS, valid supporting documents in order to proceed registration of my vehicle(s). Thereby, I am answerable for the accuracy and veracity of the documents in light of the applicable regulation.

I declare not being contractually bound to a third party supplier for the above described services, or, if required, having conducted all necessary actions for the termination of any other subscription contract taken for the above services to a third party supplier.

I wish to receive the detail of tax assessments and give, by this letter, mandate to AXXES SAS, to obtain on my behalf and my account the assessment details.List of vehicle affected by the present mandateDescription of the signatory (or the company represented by the signatory) in view of the vehicles(s)National GenderVehicle Registration Number (VRN)Vehicle Registration CountryOwnerRenteeSub renteeUserDone at . on . / . / .Before the signature, please hand-write Bon pour mandat , and stamp it with the stamp of your companyAxxs SAS au capital de 7.500.000,00 Euros Tour oxygne 10-12 Bd Vivier Merle 69393 LYON CEDEX 03 RCS Lyon 482 930 385 N TVA : FR40482930385

Documents collectionObject >>Redevable / beholdenVehicleRedevable categoryRedevable / beholden

(by default, for Ecomouv, the beholden Is the name on the vehicle registration certificate)Certificate of incorporationMandateVehicle registration certificateCertificate of conformity (COC)CEMT authorizationManufacturer certificateLeasing/rental contractOutsourcing contractCompanyOwner orLeased vehicle (for less than 3 months)MandatoryMandatoryMandatory- If no proof document for axle: number of axle will be considered as "4 and +" by Ecomouv.

- If no proof document for EURO class: Ecomouv' will use the most unfavourable Euro class.Tenant of the vehicle (for more than 3 months)orSub-tenant (for more than 3 months)MandatoryUserMandatoryAdditionalinformationAT proof, EORI proof, proof of company registration to the chamber of commerce or proof of association creationOut of UE: At least one of this 3 documents must be provided with the Vehicle registration certificate.Mandatory if name of the company is not the one mentioned on Vehicle registration certificate.Mandatory if name of the company is not the one mentioned on Vehicle registration certificate.Please find some recommendations to transfer documents :- You remain responsible of documents until they come to Shell- Always use a encrypted format using WINZIP, before sending it to Shell- Whatever is the sending format (email, USB key, CDROM), send password separately from the winzip fileSee below the process :Sending a ZIP file with encryptionStore the file on a location.Go to the location and right click on the file.Chose the option Send to -> Compressed (zipped) FolderA Zip file will be created with the same name as the original file.Open the Zip file by double clicking:Choose the option Encrypt in the menu icons:Below screen will appear that allows you to enter a password (2x)Please ensure the encryption type is set to 256-Bit AES encryption:Click on OKThe file name will now show it is encrypted as the file has a * Example.txt*The Zip file can now be attached to an e-mail and send to the receiver.

Vehicle categoryType of vehicle codeDefinitionCommentsAOtherLMotor vehicles with two or three-wheel and four motorM1Vehicles designed and constructed for carrying 9 passengers included the driverCoach companies are not liable for EcotaxM2Vehicles designed and constructed for carrying more than 9 passengers included the driver and having a maximum mass not exceeding 5 tonnesM3Vehicles designed and constructed for carrying more than 9 passengers included the driver and having a maximum mass exceeding 5 tonnesN1Vehicles designed and constructed for the transport of goods and having a maximum mass not exceeding 3,5 tonnes.N2Vehicles designed and constructed for the transport of goods and having a maximum mass between 3,5 and 12 tonnes.N3Vehicles designed and constructed for the transport of goods and having a maximum mass exceeding 12 tonnes.INot knownVehicle Country CodeALBANIAALANDORRAADAUSTRIAATBLARUSBYBELGIUMBEBOSNIABABULGARIABGCROATIAHRCYPRUSCYCZECH REPUBLICCZDENMARKDKESTONIAEEFINLANDFIFRANCEFRGERMANYDEGREECEGRHUNGARYHUIRELANDIEITALYITLATVIALVLITUANIALTLUXEMBURGLUMACDOINEMKMOLDOVIAMDNETHERLANDSNLNORWAYNOPOLANDPLPORTUGALPTROMANIARORUSSIARUSERBIARSSLOVAKIASKSLOVENIASISPAINESSWEDENSESWITZERLANDCHTURKEYTRUKRANIAUAUNITED KINGDOMGB