Bijlage B Tijdelijke regeling inzake short selling: – Meldingsformulier

Tijdelijke regeling inzake short selling

I hereby confirm that this form has been filled out truthfully: Name of contact Date Place Signature You are obliged to fill in and sign this form, and send it by fax or e-mail (scanned version of this form) or postal mail to: Netherlands Authority for the Financial Markets (AFM) Disclosure & Registration Department PO Box 11723 1001 GS Amsterdam fax number: +31 (0)20 - 797 3822 e-mail: melden.en.registreren@afm.nl

• 1. Full (statutory) name of person(s) holding the disclosable short position2The obligation applies to the holder of the net short position of 0.25% or above. See the related FAQ document for further details.:
• 2. Statutory name of the relevant financial company3You have to use separate notification forms for each financial company in which you hold a net short position of 0.25% or above:
• 3. Disclosable short position4Figure to be expressed as a percentage of the total issued share capital (see the Public Database Issued Capital on the AFM website). See the related FAQ document for further details.:
• 4. Date that disclosable short position was held:
• 1. Name:
• 2. Address:
• 3. Postal code:
• 4. Town:
• 5. Country:
• 6. Telephone number:
• 7. Fax number:
• 8. E-mail: