date: 2024-05-03 06:17:00+00:00
processor: python-docx+mammoth
status: success
Application form
for the participation at
the Extraordinary General Meeting of shareholders
to be held on 31 October 2025
of joint stock company “Amber Latvijas balzams”
unified registration No: 40003031873
legal address: Aleksandra Čaka iela 160, Riga, LV-1012, Latvia
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| Shareholder’s Name, surname /title |
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| Shareholder’s personal identification number (if the person does not have a personal identification number - the date of birth, the number, the date of issue, the country of issuance and the issuing authority of the passport or other identification document) / registration number |
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| Amount of shares represented |
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| Shareholder’s representative / proxy Name, surname |
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| Shareholder’s representatives / proxies personal identification number (if the person does not have a personal identification number - the date of birth, the number, the date of issue, the country of issuance and the issuing authority of the passport or other identification document) |
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| e-mail address |
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| Phone number |
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| Type of the participation |
🞏 in presence 🞏 remotely by electronic means of communication |
I hereby certify that a copy of the identity document of the shareholder (representative / proxy) and documents proving the representation / proxy (in case the shareholder is represented by a representative or proxy) are attached.
Date, place ________________________________
Signature _________________________________