Gentian Diagnostics ASA

Registration Form • Jan 20, 2017

Appendix 2

REGISTRATION FORM – Extraordinary general meeting of Gentian Diagnostics AS

Notice that you will attend the extraordinary general meeting on 30 January 2017 may be given with this registration form. The registration is completed by sending the registration form to Gentian Diagnostics AS, PO Box 733, NO-1509 Moss, or by e-mail: invest@gentian.no. Written proxy may be brought at the general meeting in the event that you are not able to attend in person.

I, the undersigned, will attend the extraordinary general meeting of Gentian Diagnostics AS on 30 January 2017 and vote on behalf of:

• □ Vote for my own shares
• □ Vote for other shares as specified in the enclosed proxy form

Shareholder's name and address: ______________________________________________ (please use capital letters)

___________ _________________ _________________________

date place shareholder's signature

______________________________________________