Adris Grupa D.d.ZSE: ADRS

Proxy Form for Participation in the General Assembly 2022

· Issued by Adris Grupa D.d.
ADRIS GRUPA d

Proxy Form for Participation in the General Assembly

GENERAL ASSEMBLY OF ADRIS GRUPA d.d.

Proxy

Name and surname or shareholder company/OIB

Residence or registered office of shareholder

Total number of shares of the shareholder

Number of account of the shareholder opened with the CDCC

I hereby authorize the following proxy to submit in my name and on my behalf an application for participation in the General Assembly of ADRIS GROUP d.d., Rovinj, Obala Vladimira Nazora 1, scheduled to convene on 10 June 2022 at 1 p.m., to represent me at that General Assembly, to participate in it in my name and on my behalf and to vote on all decisions made at the assembly.

Name and surname or proxy company/OIB

Residence or registered office of proxy company

This Proxy is also valid for the next General Assembly, which, in the absence of a quorum at the convened General Assembly, will be held as stated in the published invitation for participation.

Date:

Shareholder signature: