<?xml version="1.0" encoding="UTF-8"?>
<additionalVacationStatement
        xmlns="http://www.fss.ru/additionalVacationStatement"
        xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
        xsi:schemaLocation="http://www.fss.ru/additionalVacationStatement your_schema_file_name.xsd">
    <vacationStatementCalc>PRIMARYCALC</vacationStatementCalc>
    <insurerInfo>
        <insurerName>Общество с ограниченной ответственностью "Пример"</insurerName>
        <regNum>1000821775</regNum>
        <inn>9683953002</inn>
        <documentsSendPerson>
            <rank>Генеральный директор</rank>
            <fullName>
                <lastName>Иванов</lastName>
                <firstName>Петр</firstName>
            </fullName>
        </documentsSendPerson>
    </insurerInfo>
    <insuredInfo>
        <fullNamePU>
            <lastName>Сидорова</lastName>
            <firstName>Мария</firstName>
        </fullNamePU>
        <snils>12345678901</snils>
    </insuredInfo>
    <orderInfo>
        <orderNum>123-К</orderNum>
        <orderDate>2024-05-15</orderDate>
        <orderBeginDate>2024-06-01</orderBeginDate>
        <orderEndDate>2024-06-14</orderEndDate>
        <daysAmount>14</daysAmount>
    </orderInfo>
    <calculationData>
        <periodsData>
            <period>2024-02-01</period>
            <periodSumm>120000.50</periodSumm>
            <countDays>29.3</countDays>
        </periodsData>
        <periodsData>
            <period>2024-01-01</period>
            <periodSumm>115000.00</periodSumm>
            <countDays>29.3</countDays>
        </periodsData>
        <periodsData>
            <period>2023-12-01</period>
            <periodSumm>118000.75</periodSumm>
            <countDays>29.3</countDays>
        </periodsData>
        <totalSum>353000.25</totalSum>
        <totalDays>87.9</totalDays>
        <premiumSum>25000.00</premiumSum>
        <totalIncomeSum>353000.25</totalIncomeSum>
        <dailyAverageSum>4015.93</dailyAverageSum>
        <totalDaysAmount>14</totalDaysAmount>
        <vacationSum>56223.02</vacationSum>
    </calculationData>
    <receivePayment>
        <bankInfo>
            <accountNum>40702810123456789012</accountNum>
            <bik>044525225</bik>
            <bankName>ПАО "СБЕРБАНК" Г.МОСКВА</bankName>
        </bankInfo>
    </receivePayment>
</additionalVacationStatement>