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Enclosure 10 Proxy Form Enclosure 10 Enclosure 10 Proxy Form ติดอากรแสตมป์ Enclosure 10 20 บาท หนังสือมอบฉันทะ (แบบ ก.) Duty Stamp Proxy (Form A.) ----------------------------- Baht 20 เขียนที่……………………………..……...……………. Written at วันที่ ............ เดือน ......................... พ.ศ. …….....….. Date Month Year (1) ข้าพเจ้า .......................................................................................................อายุ ..................... ปี อยู่บ้านเลขที่...................................... I/We age years, residing at ถนน………………………………….……. ต าบล/แขวง ..................................................... อ าเภอ/เขต ........................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ………………...………………….. รหัสไปรษณีย์ ……………………...……………. Province Postal Code (2) เป็นผู้ถือหุ้นของ บริษัท พริมา มารีน จากัด (มหาชน) (“บริษัท”) being a shareholder of Prima Marine Public Company Limited (the “Company”) โดยถือหุ้นจ านวนทั้งสิ้นรวม .............................................หุ้น และออกเสียงลงคะแนนได้เท่ากับ ........................................เสียง ดังนี้ holding the total amount of shares and have the right to vote equal to votes as follows: □ หุ้นสามัญ ..................................................................หุ้น ออกเสียงลงคะแนนได้เท่ากับ .....................................................เสียง ordinary share shares and have the right to vote equal to votes □ หุ้นบุริมสิทธิ................................................................หุ้น ออกเสียงลงคะแนนได้เท่ากับ......................................................เสียง preferred share shares and have the right to vote equal to votes (3) ขอมอบฉันทะให้ Hereby appoint (1) ชื่อ .................................................................................................. อายุ ................ ปี อยู่บ้านเลขที่ ........................................... Name age years, residing at ถนน………………………….…………. ต าบล/แขวง .......................................................... อ าเภอ/เขต .......................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ……………………………………..….. รหัสไปรษณีย์ …………………………….…. หรือ Province Postal Code or (2) ชื่อ .................................................................................................. อายุ ................ ปี อยู่บ้านเลขที่ ........................................... Name age years, residing at ถนน………………………….…………. ต าบล/แขวง .......................................................... อ าเภอ/เขต .......................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ……………………………………..….. รหัสไปรษณีย์ …………………………….…. หรือ Province Postal Code or (3) ชื่อ .................................................................................................. อายุ ................ ปี อยู่บ้านเลขที่ ........................................... Name age years, residing at ถนน………………………….…………. ต าบล/แขวง .......................................................... อ าเภอ/เขต .......................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ……………………………………..….. รหัสไปรษณีย์ …………………………….…. หรือ Province Postal Code or ❑ (4) นายชายน้อย เผื่อนโกสุม ต าแหน่งกรรมการอิสระ อายุ 68 ปี อยู่บ้านเลขที่ 19 หมู่บ้านนวธานี ซอย 9 ถนนเสรีไทย แขวงรามอินทรา เขตคันนายาว กรุงเทพมหานคร 10230 หรือ Mr. Chainoi Puankosoom, Independent Director, Age 68 years, Residing at 19 Nawathani Village Soi 9 Serithai Rd., Ram Inthra Subdistrict, Khan Na Yao District, Bangkok 10230 or ❑ (5) นายสมชาย คูวิจิตรสุวรรณ ต าแหน่งกรรมการอิสระ อายุ 68 ปี อยู่บ้านเลขที่ 16/156 ซอยรัชดาภิเษก 36 ถนนรัชดาภิเษก แขวงจันทรเกษม เขตจตุจักร กรุงเทพมหานคร 10900 หรือ Mr. Somchai Kuvijitsuwan, Independent Director, Age 68 years, Residing at 16/156 Soi Ratchadaphisek 36 Ratchadaphisek Rd., Chan Kasem Subdistrict Chatuchak District Bangkok10900 or ❑ (6) นายโกสิทธ์ิ เฟ่ื องสวัสด์ิ ต าแหน่งกรรมการอิสระ อายุ 59 ปี อยู่บ้านเลขที่ 171/593 อาคารแอลพีเอ็นเพลส ถนนประดิพัทธ์ แขวงสามเสนใน เขตพญาไท กรุงเทพมหานคร 10400 Mr. Kosit Fuangswasdi, Independent Director, Age 59 years, Residing at 171/593 L.P.N. Place, Pradipat Rd., Sam Sen Nai Subdistrict, Phaya Thai District, Bangkok 10400 Proxy Form Page 68 Enclosure 10 คนหนึ่งคนใดเพียงคนเดียวเป็นผู้แทนของข้าพเจ้าเพื่อเข้าประชุมและออกเสียงลงคะแนนแทนข้าพเจ้าในการประชุมสามัญผู้ถือหุ้น ประจ าปี 2562 ในวันศุกร์ที่ 19 เมษายน 2562 เวลา 14.00 นาฬิกา ณ ห้องบอลรูม 1 ชั้น 5 โรงแรมเอส 31 สุขุมวิท ถนนสุขุมวิท แขวงคลองเตยเหนือ เขตวัฒนา กรุงเทพมหานคร หรือที่จะพึงเลื่อนไปในวัน เวลา และสถานที่อื่นด้วย as only one of my/our proxy to attend and vote on my/our behalf at the 2019 Annual General Meeting of shareholders on Friday, 19 April 2019 at 14.00 o’clock Ballroom 1, 5th floor, S31 Sukhumvit Hotel, Sukhumvit Road, Klongtoey-Nua, Wattana, Bangkok or such other date, time and place as the meeting may be adjourned. กิจการใดที่ผู้รับมอบฉันทะกระท าไปในการประชุมนั้น ให้ถือเสมือนว่าข้าพเจ้าได้กระท าเองทุกประการ Any acts performed by the proxy in this meeting shall be deemed to be the actions performed by myself/ourselves. ลงนาม/Signed …………………………………….. ผู้มอบฉันทะ/Grantor ( ................................................... ) ลงนาม/Signed ………………………………………ผู้รับมอบฉันทะ/Proxy (...................................................... ) ลงนาม/Signed ………………………………………ผู้รับมอบฉันทะ/Proxy (...................................................... ) ลงนาม/Signed ………………………………………ผู้รับมอบฉันทะ/Proxy (...................................................... ) หมายเหตุ/Remarks ผู้ถือหุ้นที่มอบฉันทะจะต้องมอบฉันทะให้ผู้รับมอบฉันทะเพียงรายเดียวเป็นผู้เข้าประชุมและออกเสียงลงคะแนน ไม่สามารถแบ่งแยกจ านวนหุ้นให้ ผู้รับมอบฉันทะหลายคนเพื่อแยกการลงคะแนนเสียงได้ The shareholder appointing the proxy must authorize only one proxy to attend and vote at the meeting and may not split the number of shares to many proxies for splitting votes. Proxy Form Page 69 ติดอากรแสตมป์ Enclosure 10 20 บาท หนังสือมอบฉันทะ (แบบ ข.) Proxy (Form B.) Duty Stamp Baht 20 เขียนที่……………………………..……...……………. Written at วันที่ ............ เดือน ......................... พ.ศ. …….....….. Date Month Year (1) ข้าพเจ้า .......................................................................................................อายุ ..................... ปี อยู่บ้านเลขที่...................................... I/We age years, residing at ถนน………………………………….……. ต าบล/แขวง ..................................................... อ าเภอ/เขต ........................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ………………...………………….. รหัสไปรษณีย์ ……………………...……………. Province Postal Code (2) เป็นผู้ถือหุ้นของ บริษัท พริมา มารีน จากัด (มหาชน) (“บริษัท”) being a shareholder of Prima Marine Public Company Limited (the “Company”) โดยถือหุ้นจ านวนทั้งสิ้นรวม .............................................หุ้น และออกเสียงลงคะแนนได้เท่ากับ ........................................เสียง ดังนี้ holding the total amount of shares and have the right to vote equal to votes as follows: □ หุ้นสามัญ ..................................................................หุ้น ออกเสียงลงคะแนนได้เท่ากับ .....................................................เสียง ordinary share shares and have the right to vote equal to votes □ หุ้นบุริมสิทธิ................................................................หุ้น ออกเสียงลงคะแนนได้เท่ากับ......................................................เสียง preferred share shares and have the right to vote equal to votes (3) ขอมอบฉันทะให้ Hereby appoint (1) ชื่อ .................................................................................................. อายุ ................ ปี อยู่บ้านเลขที่ ........................................... Name age years, residing at ถนน………………………….…………. ต าบล/แขวง .......................................................... อ าเภอ/เขต .......................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ……………………………………..….. รหัสไปรษณีย์ …………………………….…. หรือ Province Postal Code or (2) ชื่อ .................................................................................................. อายุ ................ ปี อยู่บ้านเลขที่ ........................................... Name age years, residing at ถนน………………………….…………. ต าบล/แขวง .......................................................... อ าเภอ/เขต .......................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ……………………………………..….. รหัสไปรษณีย์ …………………………….…. หรือ Province Postal Code or (3) ชื่อ .................................................................................................. อายุ ................ ปี อยู่บ้านเลขที่ ........................................... Name age years, residing at ถนน………………………….…………. ต าบล/แขวง .......................................................... อ าเภอ/เขต .......................................................... Road Tambol/Khwaeng Amphur/Khet จังหวัด ……………………………………..….. รหัสไปรษณีย์ …………………………….…. หรือ Province Postal Code or ❑ (4) นายชายน้อย เผื่อนโกสุม ต าแหน่งกรรมการอิสระ อายุ 68 ปี อยู่บ้านเลขที่ 19 หมู่บ้านนวธานี ซอย 9 ถนนเสรีไทย แขวงรามอินทรา เขตคันนายาว กรุงเทพมหานคร 10230 หรือ Mr. Chainoi Puankosoom, Independent Director, Age 68 years, Residing at 19 Nawathani Village Soi 9 Serithai Rd., Ram Inthra Subdistrict, Khan Na Yao District, Bangkok 10230 or ❑ (5) นายสมชาย คูวิจิตรสุวรรณ ต าแหน่งกรรมการอิสระ อายุ 68 ปี อยู่บ้านเลขที่ 16/156 ซอยรัชดาภิเษก 36 ถนนรัชดาภิเษก แขวงจันทรเกษม เขตจตุจักร กรุงเทพมหานคร 10900 หรือ Mr. Somchai Kuvijitsuwan, Independent Director, Age 68 years, Residing at 16/156 Soi Ratchadaphisek 36 Ratchadaphisek Rd., Chan
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