Proxy Solicitation & Information Statement • Apr 14, 2011
Proxy Solicitation & Information Statement
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| Undersigned (name, christian name) …………………………………………….…, residing at: ………… | ||||||||
|---|---|---|---|---|---|---|---|---|
| ………………………………………………………… owner of ………… Campine shares, hereby declares | ||||||||
| to | give | full | attorney | to | (name, | christian | name) | …………………. ………. |
| ……………………………………………, | residing | at | ………………………………… | |||||
| ……………………….……… …………………who is a shareholder of Campine himself / herself, to |
Proposal to renew the mandate of the Auditor as the mandate of the Auditor of Deloitte Bedrijfsrevisoren, represented by Mr Luc Van Coppenolle will expire.
Drawn up in ……………………. on ……………………………………..
The owner the proxy (signature) (signature)
Good for proxy for acceptance
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