PROXY AUTHORIZATION LETTER – NATURAL PERSON
PROXY AUTHORIZATION LETTER for the 25th General Meeting of the company Pivovarna Laško, d.d., Trubarjeva 28, 3270 Laško
___________________________________________ (first and last name of shareholder)
___________________________________________ (shareholder personal registration number – EMŠO)
___________________________________________ (shareholder address)
hereinafter: the Authorizing Entity
hereby authorize _________________________________ (first and last name/company name of the proxy):
_________________________________
(proxy personal registration number – EMŠO / registration number)
_________________________________ (proxy address/seat)
_________________________________ (first and last name of the proxy representative, if the proxy is a legal person)
hereinafter: the Proxy, to attend on my behalf the 25th General Meeting of the company Pivovarna Laško, d.d., Trubarjeva 28, 3270 Laško, taking place on Monday, April 11, 2016, at 15:00 in the business premises of Pivovarna Laško, d.d., and exercise there the voting right pertaining to all my shares of the issuer Pivovarna Laško, d.d., code PILR. In _______________on _________________________________ (place)
this
(date)
(first and last name, and signature of shareholder)
_____________