ENVIPCO HOLDING N.V.

Van Asch van Wijckstraat 4, 3811 LP

AMERSFOORT, THE NETHERLANDS

ANNUAL GENERAL MEETING OF SHAREHOLDERS OF

ENVIPCO HOLDING N.V. HELD WEDNESDAY 23 JUNE 2021

Registration Form for holders of Depository Receipts

The undersigned:

_________________________________________ (name)

_________________________________________ (address)

_________________________________________ (zip code / city)

_________________________________________ (country)

_________________________________________ (e-mailaddress)

hereby applies for registration for the annual general meeting of shareholders of Envipco Holding N.V. (the "Company") to be held on Wednesday 23 June 2021 at 14:00 hours (CEST) at the Company's offices at Van Asch van Wijckstraat 4, 3811 LP, Amersfoort, The Netherlands.

As evidenced by the attached statement of ________________________________ (custodian bank), at the

Record Date, the undersigned was the legal and beneficial holder of __________________________

Depositary Receipts. This application for registration regards the aforementioned number of Depositary Receipts.

Signed in:

on:

2021

By:Title:

Duly completed and signed form accompanied with a statement of the custodian bank via which the Depositary Receipt holder is holding his/her Depositary Receipts to be sent no later than Wednesday 16 June 2021 before 17:00 CEST to ABN AMRO at ava@nl.abnamro.comand the Company at derkv@envipco.com.

The aforementioned statement of the applicable custodian bank must include the beneficial owner details of the Depositary Receipt holder, the number of Depositary Receipts held by the relevant Depositary

Receipt holder on the Record Date and the number of Depositary Receipts which have been applied for registration.

Upon due registration, the holder of the Depositary Receipts will be granted a power of attorney by DNB Bank ASA in its capacity as the VPS Registrar on the basis of which the holder of the Depositary Receipts shall be entitled to vote on the shares underlying the duly registered Depositary Receipts.

Upon due registration, ABN AMRO will issue a registration certificate for the registered holder Depositary Receipts which shall be provided via the email address included in the registration form.

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Envipco Holding NV published this content on 12 May 2021 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 13 May 2021 20:27:04 UTC.