MODULO DI DELEGA

TISCALI S.p.A. – Extraordinary shareholders’ meeting of 30 January 2015 – Proxy Form
Complete with the information required, sign and send to the Company based on the Instructions shown in the footnotes 1
Mr./Mrs. 2…………............................................................................................... born in ................ ....................... on .............. Tax Code ………………………….........
resident in (city) ………………………………….......................... in (street) ………………………………………………………………………………
holder of no. ............................ Tiscali shares
deposited in securities account3 no. …………………….… at ……………………………………………………………………………….. ABI (bank code)…………… CAB
(sort code)….………..
as per communication no.4 …………………………..............sent by …………………………………………………………………………..
DELEGATES
5
………………………………………………………………………………………………………..
to attend and represent him/her at the extraordinary shareholders’ meeting of Tiscali S.p.A. called for 30 January 2015 at 11am at the registered office in Cagliari,
Sa Illetta district, s.s. (State Road) 195 km. 2,3 in single call.
The undersigned 6 …………………………………………………………………………………
DECLARES that he/she is the holder of voting rights pertaining to the above-mentioned shares and is signing this proxy as (tick the necessary box):
 legal representative -  proxy with substitute agent powers -  secured creditor -  contango broker -  usufructuary -  custodian -  manager  other (specify) …………………
DATE ....................... Identity document 7 (type) ………………….…. issued by ………………….. no. ………………………. SIGNATURE ....................................................
Instructions for compilation and transmission
1
The original Proxy form must be sent to the delegate and delivered by the latter to the Company upon confirmation. It is also possible to send a copy of the
proxy in advance directly to the Company via:
 fax to the no. +39.070.460.1482
 an attachment to a certified e- mail to the address: [email protected]
Any prior notification of the proxy does not exempt delegates, at the time of validation for access to shareholders’ meetings, from the obligation to certify, under
their own responsibility, compliance of the original proxy and the identity of the delegating party.
2
Indicate name and surname or name of the nominee of the shares as shown in the communication sent by the intermediary to the Company.
3
Quote the number of the securities account, the ABI and CAB numbers of the depositary intermediary, or, in any case, its name, taken from the statement of the
securities portfolio.
4
Any reference to the communication sent by the intermediary and his/her name, if different from the depositary of the securities account.
5
Indicate the name and surname of the proxy.
6
Indicate the name and surname of the signatory holding the voting right and his/her capacity only if different from the share nominee stated above.
TISCALI S.p.A. – Extraordinary shareholders’ meeting of 30 January 2015 – Proxy Form
7
Quote the references of a valid identity document of the signatory of the proxy.