Elos Medtech : Proxy form

Proxy Form

The following proxy holder are hereby authorised to exercise the below shareholder's rights at the Extraordinary General Meeting of Elos Medtech AB (publ). Unless otherwise stated below, the proxy form only applies to the Extraordinary General Meeting 13 August 2021.

• The proxy form shall apply up until

(please enter date; no more than five years from issuance of the proxy):

• The proxy form shall notapply to all the shareholder's shares but for the following number:

Proxy Holder

Name:	SSN/Personal id.no:
Address:	Phone number (daytime):

Shareholder

Name:	Personal id. no or organisation id. no:
Address:	Phone number (daytime):
Place and date:

Shareholder's signature or, if a legal person, authorised signatory:

Printed name:

Please note that if the shareholder is a legal person the proxy must be signed by authorised signatory for the legal entity along with authorisation documents to be attached.

The completed proxy form (with any attachments) in original should be sent to Elos Medtech AB (publ), Extraordinary General Meeting 2021, c/o Advokatfirman Vinge KB, Box 11 025, 404 21 Göteborg well in time before the Extraordinary General Meeting.