Latvijas Gaze

Regulatory Filings • Jan 3, 2024

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date: 2023-12-28 09:32:00+00:00
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APPLICATION FORM FOR REMOTE PARTICIPATION

At Extraordinary General Meeting of shareholders

to be held on February 22, 2024

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)
Method of participation (remotely / present in person)
e-mail address
Phone number

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 _________________________________