PROXY AUTHORIZATION LETTER – NATURAL PERSON
PROXY AUTHORIZATION LETTER for the 24th 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 24th General Meeting of the company Pivovarna Laško, d.d., Trubarjeva 28, 3270 Laško, taking place on Thursday, November 12, 2015, at 09:00 in the main hall of the Laško Cultural Centre, Trg svobode 6, Laško, 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)
_____________