<?xml version='1.0' encoding='UTF-8'?>
<AADD001 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="AADD001_20261.xsd">
	<Form>
		<Identification>AADD001</Identification>
		<FormCreationDate>2021-05-16</FormCreationDate>
		<FormCreationHour>08:55:13.084</FormCreationHour>
		<AttestationStatus>0</AttestationStatus>
		<TypeForm>RE</TypeForm>
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			<ReferenceNbr>255976FF036</ReferenceNbr>
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		<AskedDeclaration>
			<Identification>ZIMA001</Identification>
			<ParticularSituationIndicator>0</ParticularSituationIndicator>
			<ReferencePeriod>
				<RefStartingDate>2021-05-06</RefStartingDate>
			</ReferencePeriod>
			<MiniDmfaQuarter>
				<Quarter>20212</Quarter>
			</MiniDmfaQuarter>
		</AskedDeclaration>
		<CoordinatesContactPerson>
			<Name>Smith</Name>
			<FirstName>John</FirstName>
			<Address>
				<Street>Teststraat</Street>
				<HouseNbr>30</HouseNbr>
				<ZIPCode>6000</ZIPCode>
				<City>Charleroi</City>
				<Country>150</Country>
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			<Communication>
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				<EmailAddress>js@mediatest.be</EmailAddress>
			</Communication>
		</CoordinatesContactPerson>
	</Form>
</AADD001>