Fabryki Mebli FORTE S A : Statement for candidates for Members of the Supervisory Board of FABRYKI MEBLI “FORTE” S.A.

Full name: __________________________

FABRYKI MEBLI "FORTE" S.A. ul. Biała 1

07-300 Ostrów Mazowiecka

STATEMENT

I, the undersigned _______________________________________________________________, express

my consent to stand as a candidate and serve as a member of the Supervisory Board of a company operating under the business name of FABRYKI MEBLI "FORTE" Spółka Akcyjna based in Ostrów Mazowiecka (KRS no. 0000021840).

I declare that I meet all the criteria applied to a candidate for a member of the Supervisory Board of FABRYKI MEBLI "FORTE" S.A., in particular the following:

• I havefull legal capacity and I have not been convicted in a final and unappealable judgment for offences under Chapters XXXIII-XXXVII of the Criminal Code and under Articles 587, 590 and 591 of the Commercial Companies Code, and there are noobstacles for me to serve as a member of the Supervisory Board listed in Article 387 of the Commercial Companies Code.
• I am involved / I am not involved in any activity competitive* to FABRYKI MEBLI "FORTE" S.A. based in Ostrów Mazowiecka and I participate / nor do I participate* in a competing company as a partner in a civil law partnership or any other partnership or as a member of a governing body of a competitive capital company or a member of a governing body of any competitive legal entity.*
• I am / I am not** recorded in the Register of Insolvent Debtors maintained under Article 55 of the National Court Register Act.
• I meet / I do meet the independence criteria** listed in the Act of 11 May 2017 on Statutory Auditors, Audit Firms and Public Oversight.
• I have / I do not have** real and significant ties with a shareholder holding at least 5% of the total number of votes at FABRYKACH MEBLI "FORTE" S.A.

My address for service is: ________________________________________________

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(place, date)	(signature)

• Delete if not applicable. If the candidate is involved in activity competitive to FABRYKI MEBLI "FORTE" S.A., please specify the type of the activity. ** Delete if not applicable.

PRIVACY NOTICE

Pursuant to Article 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation - hereinafter: GDPR), FABRYKI MEBLI "FORTE" S.A. hereby informs you that:

1. the controller of your personal data is FABRYKI MEBLI "FORTE" S.A. based in Ostrów Mazowiecka (07-300 Ostrów Mazowiecka, ul. Biała 1),
2. for matters related to the protection of personal data, you can contact the controller at email address: [e-mail] in writing to the address of the controller's registered office,
3. your personal data provided in the above Statement will be solely processed by FABRYKI MEBLI "FORTE" S.A. to contact you in connection with you standing as a candidate and a possible member of the Supervisory Board of FABRYKI MEBLI "FORTE" S.A. that you consented to. The basis for data processing is your consent, which is voluntary but necessary to stand as a candidate and a possible member of the Supervisory Board (Art. 6(1)(c) GDPR) and a legal obligation to which the controller is subject (Art. 6(1)(f) GDPR),
4. recipients of your personal data may include competent authorities acting in accordance with applicable laws. In addition, your data may be transferred to entities contracted to process personal data on behalf of the controller, including IT service providers, in which case the data is processed by these entities on the basis of an agreement made with the controller and only in accordance with the instructions provided by the controller,
5. your data will be processed for the duration of the election of members of the Supervisory Board and if elected as a member of the Supervisory Board for the period of serving as a member of the Supervisory Board, and once you have ceased to serve as a member of the Supervisory Board for purposes related to the performance of obligations under the law, including in particular tax and accounting obligations,
6. you have the right to request access to and rectification or erasure of your personal data, to object to or request restriction of processing concerning the data, or the right to data portability. In addition, you have the right to withdraw your consent to the processing at any time, which shall not affect the lawfulness of processing based on consent before its withdrawal,
7. if you believe that the processing of your personal data violates the provisions of GDPR, you have the right to lodge a complaint with the President of the Personal Data Protection Office (Prezes Urzędu Ochrony Danych Osobowych),
8. your data will not be transferred to third countries or international organisations,
9. providing your personal data is voluntary but necessary to stand as a candidate of the Supervisory Board and to serve as a member of the Supervisory Board and to perform all of our obligations under the law,
10. the controller is not involved in any form of automated processing of your personal data, including profiling.

I consent to the processing and publication of my personal data within the meaning of the Personal Data Protection Act of 10 May 2018 (Journal of Laws Dz.U. No. 1000 of 25 May 2018) and Regulation (EU) 2016 / 679 of the European Parliament and of the Council on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC.

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(place, date)	(signature)