Proxy Solicitation & Information Statement • Apr 27, 2012
Proxy Solicitation & Information Statement
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| The undersigned: |
|---|
| Surname, first name |
| Domicile: |
| owner of share(s) in the NATIONAL BANK OF BELGIUM, hereby declare that I assign full power to: |
| Surname, first name |
| Domicile: |
| Pursuant to Article 547bis, §4 of the Companies Code, in the event of any potential conflict of interests between a shareholder and his appointed representative, the representative is not authorised to exercise the voting right on behalf of the shareholder unless he has specific voting instructions for each item on the agenda. Without that, proxies will not be valid. |
| Conflicts of interest exist in particular if the representative: |
| 1° is the Bank, is a shareholder who controls the Bank or is another entity controlled by such a shareholder; |
| 2° is a member of the Bank's Board of directors, or a member of the management bodies of a shareholder who controls the Bank or a controlled entity referred to in 1°; |
| 3° is an employee or external auditor of the Bank or of the Bank's controlling shareholder or of a controlled entity referred to in 1°; |
| 4° is related to a natural person referred to in 1° to 3° or is the spouse or legal partner of such a person, or of a relation of such a person. |
| Proxies returned to the Bank without indicating a representative will be deemed to be addressed to the chairman of the Board of Directors and consequently fall within the scope of potential conflicts of interest. They will not be valid unless voting instructions are indicated for each item on the agenda. |
| to |
(tick the appropriate box if you are in the situation of a potential conflict of interests - see box above)
For Mr Rudi Thomaes
For Mr Pieter Timmermans
Abstention
Renewal of the term of office of Mrs Sonja De Becker
For Mrs Sonja De Becker
For Mr Rudy Gotzen
Abstention
Renewal of the term of office of Mrs Michèle Detaille
For Mrs Michèle Detaille
For Mr Michel Moll
Abstention
Replacement of Mr Luc Cortebeeck
For Mr Marc Leemans
For Mr Paul Scheins
Abstention
Replacement of Mrs Martine Durez
For Mr Jean-Louis Six
For Mr Gilles Mahieu
Abstention
Censors: Renewal of the term of office of Mr Philippe Grulois
For
Abstention
Renewal of the term of office of Mr Jean-François Hoffelt
For
Abstention
Renewal of the term of office of Mr Bernard Jurion
For
Abstention
In the case of extra items added to the agenda and proposals for decisions relating to them in accordance with Article 533ter of the Companies Code after notification of this proxy, the
(tick the appropriate box)
| is authorised to vote on the new items entered on the agenda | ||
|---|---|---|
| must abstain | ||
| Done at | (date) | |
| THE SHAREHOLDER (Signature) (1) |
Signature Field |
(1) If the form is completed electronically, it must bear an electronic signature conforming to the legal requirements concerning electronic signatures.
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