Tijdelijke Regeling Inzake Melding van Short Posities

• 1.

  Full (statutory) name of person(s) holding the disclosable short position²The obligation applies to the holder of a disclosable short position. 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 disclosable short position.:

• 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:

Contact

• 1.

  Name:

• 2.

  Address:

• 3.

  Postal code:

• 4.

  Town:

• 5.

  Country:

• 6.

  Telephone number:

• 7.

  Fax number:

• 8.

  E-mail:

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