Carlson Investments Se

Proxy Solicitation & Information Statement • Dec 8, 2023

POWER OF ATTORNEY

I ..................................., PESEL ........................... domiciled in ............................., hereby grant to Mr./Ms.................., holding ą identity card series ...... no. ......, domiciled in ......................, the power of attorney to participate in and exercise voting rights from the shares in CARLSON INVESTMENTS SE held by me as a shareholder ....................... at the Extraordinary General Meeting convened for January 4, 2024.

Within the scope of the subject matter of this power of attorney, the proxy is authorized to perform all actions related to the purpose of this power of attorney, in particular to:

1) to make proposals;

2) exercise of voting rights;

3) raising objections.

This power of attorney is exempt from stamp duty, due to the fact that this type of power of attorney is not covered by the Act of July 16, 2006 on stamp duty (i.e., Journal of Laws 2023, item 2111).

Caption: ...................................................................

..................................., ........................ r. [Locality].