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Equity Capital - Status of Shares

(relevant for companies with secondary listing)

Alternatively, this form may be sent to the SIX Swiss Exchange by fax or post.

Name of the company*

Last name*

First name*

E-mail*

Phone*

Reporting of the current number of quoted shares

Title category*

ISIN*

The above mentioned company is primary listed on the following exchange*

Status as of the end of*

Number of shares*

Currency*

Nominal Value*

Publications