Amber Latvijas balzams

Registration Form • Oct 10, 2025

---

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

Shareholder’s Name, surname /title
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
Amount of shares represented
Shareholder’s representative / proxy Name, surname
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)
e-mail address
Phone number
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 _________________________________