Amber Grid — Proxy Solicitation & Information Statement 2017

May 9, 2017

Translation from the Lithuanian

Annex 3

AB Amber Grid

GENERAL BALLOT PAPER

GENERAL MEETING OF SHAREHOLDERS OF 31 MAY 2017

INFORMATION ABOUT SHAREHOLDER

Name of the shareholder:

Code of the shareholder:

Number of shares:

VOTING

Please circle the voting option elected: "FOR" or "AGAINST"

No	Issue on the agenda	Draft resolution proposed	Expression of shareholder's volition
1.	The election of the Audit Company and determining the terms of compensation for audit services for the year 2017.	To elect UAB PricewaterhouseCoopers as the Audit Company to perform the audit of AB Amber Grid financial statements as of 31 December 2017 (drawn up in accordance with the International Financial Reporting Standards and of the Annual Report and regulated activity financial statements prepared in accordance with the requirements established by the Law on	“FOR”	“AGAINST”
		the number of shares of AB Amber Grid financial statements.
2.	The financial statements of the Audit Company and the other agencies in the year 2017.	To elect UAB PricewaterhouseCoopers as the Audit Company to perform the financial statements of the Audit Company and the other agencies in the year 2017.	“FOR”	“AGAINST”

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2

		Natural Gas and secondary legislation) and to set remuneration for the services of the audit of the financial statements and related statements at EUR 15,910 (excluding VAT).

Note:

1. As provided by the law, all draft resolution proposals, if any, received before the date of posting off of the General Ballot Paper will be included in the General Ballot Paper.

(Date)

Name, surname, position, signature of a shareholder (or any other person, authorized to vote his shares)