Carlson Investments Se

Proxy Solicitation & Information Statement • Dec 24, 2021

POWER OF ATTORNEY

I, ..................................., PESEL ........................... domiciled in ............................., hereby grant to Mr./Ms. ................., holding a ...... series ID card no. ......, domiciled in ......................, a power of attorney to participate in and exercise voting rights attached to the ....................... shares of CARLSON INVESTMENTS S.A. held by me at the Extraordinary General Meeting convened for January 20, 2022.

Within the scope of the subject matter of this power of attorney, the attorney-in-fact is authorized to perform all acts related to the purpose of this power of attorney, including, but not limited to:

1) making motions; 2) exercise of voting rights;

3) to raise objections.

This power of attorney is exempt from stamp duty, as this type of power of attorney is not covered by the Act of July 16, 2006 on stamp duty (Journal of Laws of 2020, item 1546).

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

…………………………….., ........................ r.

[Locality].