Latvijas Gaze — Proxy Solicitation & Information Statement 2021

Jul 12, 2021

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date: 2021-07-12 06:57:00+00:00
processor: python-docx+mammoth
status: success

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Application form

for the participation at

Extraordinary General Meeting of shareholders

to be held on September 6, 2021

of joint stock company “Latvijas Gāze”

unified registration No: 40003000642

legal address: Aristida Briāna iela 6, Rīga, LV-1001, 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 considering restrictions set out by the government of Republic of Latvia due to the Covid-19 pandemic 🞏 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 _________________________________