Medistim — Proxy Solicitation & Information Statement 2010

Apr 23, 2010

Attendance form general meeting in MediStim ASA

The undersigned will attend the general meeting in MediStim ASA the 29th of April 2010 at starting at 09.00

Shareholders name

Number of shares

Place

Date

Shareholders signature

---

Power of attorney

The undersigned, ____, that owns
____ shares in MediStim ASA herby give _______
power of attorney to attend and vote for my shares at the general meeting in
MediStim ASA the 29th of April 2010.

Place ____
Date ____

Shareholders signature ____
Shareholders name in block letters ____

(Companies must attach a copy of company registration of newer date to prove correct signature.)