XTPL S.A.

Proxy Solicitation & Information Statement • May 31, 2024

POWER OF PROXY TEMPLATE

POWER OF PROXY

(place, date)

_____________________

Shareholder's name/ name and surname*: Shareholder's address: KRS number/ NIP/ Other registry number of the shareholder*: Shareholder's PESEL*: Contact email: Contact phone number:

("Shareholder")

The Shareholder hereby appoints:

(proxy details, in particular name and surname/ name, PESEL number or other identification number/ address for notices, number of the identity document)

____________________________________________________________________________________________

as a proxy to represent the Shareholder by participating in and exercising voting rights attached to (number of shares) _____________of shares of XTPL S.A. with its registered office in Wrocław, held by the Shareholder, at the Extraordinary General Meeting of XTPL S.A. with its registered office in Wrocław (KRS No. 0000619674), to be held on 21 June 2022.

The Shareholder authorises the proxy to act independently and represent the Shareholder with the right to exercise voting rights attached to (number of shares) _____________ shares held by the Shareholder and recorded in account no. ______________ (provide the number of the account in which the shares are recorded) kept by ___________ (specify the entity maintaining the account in which the shares are recorded), in accordance with the attached form of proxy/ at the discretion of the proxy*.

The proxy shall have right to perform any other acts in law and acts in fact as may be necessary to carry out the power of proxy.

The proxy is authorized to represent the Shareholder also in the event of a break in the General Meeting proceedings.

The proxy shall have/ shall not have* a power of substitution.

This power of proxy is accompanied by a form of proxy document.*

………………………………………….. (signature of the Shareholder or his representative)

* delete if not applicable