Green Hydrogen Systems

Legal Proceedings Report • Mar 25, 2025

Appendix 1 - Acceptance Statement

The undersigned creditor

______________________

_______________________

_______________________

[please write name and address above in capital letters]

being a creditor of Green Hydrogen Systems A/S under rekonstruktion (in restructuring), Nordager 21, DK-6000 Kolding, Danish CVR no. 30548701, and having a total receivable of

DKK___________________

hereby accepts the restructuring plan received.

In connection with accepting the restructuring plan, the undersigned creditor hereby authorises Attorney Henrik Sjørslev, or any substitute appointed by him, to appear on my/our behalf before the Bankruptcy Court of Kolding in restructuring case no. SKS 6-94/2025 on 1 April 2025 at 10.30 am and vote in favour of the adoption of the restructuring plan.

Date: ______________

Name of signer: __________________________

_______________________________

If the claim has not already been filed with the restructuring administrator, this Statement should be accompanied by documentation for the claim.