Latvijas Gaze — Proxy Solicitation & Information Statement 2021

Jul 12, 2021

---

title: "Form of power of attorney"
author: "Martins_Zemzaris"
date: 2021-07-12 06:01:00+00:00
processor: python-docx+mammoth
status: success

---

Form of power of attorney

according to the Clause 54 Part two Point one of the Financial instruments market law

___________________________

Place and date of issuance

Power of attorney

_____________________________________________________________________________

Natural person - name, surname, 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) or legal person - company name, registration number, legal address, representative, grounds of representation, as principal

authorizes

_____________________________________________________________________________

Natural person - name, surname, 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) or legal person - company name, registration number, legal address, as proxy

______to represent the interests of principal at________

(the exact scope of competence can be specified if needed)

_____________________________________________________________________________

Date of the shareholders’ meeting and type – annual or extraordinary general meeting

of the Joint Stock Company „Latvijas Gāze” (registration number: 40003000642, legal address: Aristida Briāna iela 6, Riga, LV-1001, Latvia)

with ______________________________________________ shares belonging to the principal.

(all or specifying an exact amount of shares)

The power of attorney is issued ______________ subdelegation rights.

(with or without)

The power of attorney shall continue effective _____________________.

(date)

_____________________

Principal – signature, name, surname