IMPORTANT :Avant d'exercer votre choix, veuillez,.Prendre connaissance des instructions situees au verso • Important : Before selecting please refer to instructions on reverse side
A. 0 Je desire assister a cette assemblee et demande une carte d'admission :dater et signer au bas du formulaire I I wish to attend the shareholders' meeting and request an admission card : date and sign at the bottom of the form.
B. J'utillse le formulaire de vote par correspondance ou par procuration cl-dessous, selon l'une des 3 possibilites offertes / I prefer to use the postal voting form or the proxy form as specified below.
Quelle que soit l'option choisie, noircir comme ceci la ou les cases correspondantes, dater et signer au bas du formulaire - Whichever option is used, shade box(es) like thisl date and sign at the bottom of the form
GENSIGHT BIOLOGICS
SA a conseil d'administration au capital de 488 511,33 €
Siege social : 74 rue du Faubourg Saint Antoine 75012 - PARIS
751 164 757 RCS PARIS
CADRE RESERVE A LA SOCIETE - FOR COMPANY'S USE ONLY
ldentifiant - Account
Voto simple
Single vote
ASSEMBLEE GENERALE MIXTE
Convoquee le 31 mai 2017 a 9 heures,
74 rue du Faubourg Saint-An'oine.
Nombre d'acllons
Number of shares
Nominatif
Rogistered
75012 Paris
[
[Porteur
BearerVoto double
Double vote
COMBINED GENERAL MEETING
To be held on May 31th. 2017 at 9:00 a.m.
Nombre de voile - Number of voting rights
74 rue du Faubourg Saint-Antoine, 75012 Paris
D JE DONNE POUYOIR,Al! PRESIDENT
DE L'ASSEMBLEE GENERALE
Cf. au verso (3)
I HEREBY GIVE MY PROXY TO THE CHAIRMAN OF THE GENERAL MEETING
See reverse (3}
O JE DONNE POUVOIR A :Ct. au verso (4)
I HEREBY APPOINT : see reverse (4)
M.,Mme OU Mle, Raison Sociale IMr, Mrs or Miss, Co,porate Name
Adresse I Address
O JE VOTE PAR CORRESPONDANCE / I VOTE BY POST
! Ct. au verso (2) - See reverse (2}
1-- ---1
8 Je vote OUI a touslos projots de resolutions presontes ou agrMs parle Surles projets de resolutions non agrees parle
:c Conseild'Administratlon oule Olrectolre oula Gerance, a !'EXCEPTION de Conseil d'Administration oule Oirectolre oula
ceux quo Jo slgnalo en nolrclssant comme ceci la case correspondante et Gerance, Je vote en nolrclssant commo ceci la pourlosquels je vote NON ou je m'absliens. case correspondant a mon choix.
o I vote YES all the draft resolutions approved by the Board of Directors On the draft resolutions not approved by the EXCEPT those Indicated by a shaded box - /Ike this I.for which I vote NO Board of Directors, I cast my vote by shading the or I abstain. box of my choice - like this I.
i1-- -+- --1
!
Oul I Non/No Out I Non/No
ATTENTION :s' l s'aglt de titres au porteur,les prosontos instructions ne seront valldes que si ellos sont directemont retournees a votre banque.
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1 2 3 4 5 6 7 8 9
0 0 0 0 0 0 0 0 0
Yes Abst/Abs Yes Abst/Abs
0 | 0 | F | O | 0 | |
0 | 0 | I | G | O | 0 |
I A
CAUTION :
if it is about bearer securities, the present instructions will bo valid only if they are directly returned to your bank.
a
w
(J}
Nom,prenom, adresse do l'actionnaire (les modifications de ces informations doivont etre adressaes et ne peuvont etre offoctucles a l'aide de ce formulaire). Ct au verso (1)
l'etabllssement conceme
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iii
x
w
10 11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0 0 I B
c
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0 I
28 29 30 31 32 33 34 35 36
I H O 0
Surname. first name, address of tho shareholder (Change regarding this information have to bo notified to relevant Institution, no change can be made using this pro")' form}.See reverse (1}
w
0
i5 0 0 0 0 0 0 0 0 0 I D
w
a:
5 37 38 39 40 41 42 43 44 45
I J 00
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0 | 0 |
0 | 0 |
0 | 0 |
0 0 0 0 0 0 0 0 0 I E
K O 0
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Sidesa,, ,e,Iden oeiits ou desresollJtions nouwles etlient pnismtesen assembJl,e I klcase imend7iencs or re.viesoW:.-.s srepropoood dmgthe
-Jedome p(llM)r w Pnsident defassartiltlog,!rhlEdede'enmon nom / apponthe C'l1anna-l the fP'rr,J moo/ir,;J II:>ldla,mybelwf...... O
.Je m'ab6tiens fabslenlion eq.iv.u a..,loQleccnlro)./ 1absmi> lh:>tn K>1W,g r,secp.,aert 11:> "'*'l'IJJ0
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Pour etre prise en consid6ration,toute formulo dolt parvenlr au plus tard :
In order to be considered, this completed fonn must be retumod at tho latost
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sur 1- convocation I on 1st notnication sur 2'"' convocation I on 2nd notnteation
iila banque I to the bank 27mai 2017/ May 27th,2017
a la societe I to the company
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CONDITIONS D'UTILISATION DU FORMULAIRE
(1) GENEllAUTES d '°J'' d, ' M •o,10 un,que r,&,o p,r a,OJ (c,:;., de UYnme«e oque ,.,,. [C!J',:,1 C".O•• -':TO'pt,._ d l"SCfnJ :r E'·:X.t. 0-11, a ,one ..eir.-1 ".' a eel effe!, non en mouX:!e!l pceoori f..lJl!'I e' od1 ,l:-:s n-«U,cOflon:. do: c ,d:y-o+,or.!. dor. t ef:f!o&e,s!,o l'elld-'l'le!'1f corl'"kirie tot rP,'I.I, ,1 !rl' ··ff.x).00 o l'ode de ce loi"'lo,ie) Pw le! pnoroles. ',e s,g110''J.1>: d?il rH":g M.,,. prl>.J'lOtl'I ·"" q1JO! hl s. le YJrcJ!a,'(! n'I!".: po rxt·Cfl"'01le le,errple IT111'1'To"ei.ll I l.1:1JI_ e!( I 11 d,1 !lf.'t,1-y.r.er - ::,enw ;;, o quo! ie ee laquelie ,:,g· le k,mulo ,e 6'! """ ,e- li:,ur.i.«)1:t:• od1 p::-...1 une C.:.!terr-blre ,·VJ.JI pour 11!1 ::merr,bs succe,. s CO".. l.;....S o,l!C le rr,t!rrllj .Yd:!'!' du (ortP. 225 77 o ,nee 3 du Coo.,"" (e .e- ·oo:. cd:1cru l,gurc dJns ,e 'Y.)5. oe cor,. o"t0n 101,.1 O·J prY!'f',1 1E>frt,i,lon,!' 101!.("Je P 225-B' du Code oe (omrrr.e-1 r·,k rm I ',:""" 0 la ;()I,, f je · par CO""e!.pO,"'O:nce • • .l,e 00'/·ie pot.· , .IA-t1oe p 225-8 Ced, d, (O(T'r-"rc:la .t'f:.ion fron.;o se cl.! e doa.irnnt b.1 k• | (31 POUVOIR AU PRESIDENf DE l'ASSEM8lfE GENERAL£ Ar,cle l225 106 du Code de Cc,rc.,,•cce ,.,. o ti ·•.,.. ;;J.,."e prc.curot..,;. d'i.0...;:,!! ,rod,.1 r"'Q'Y.)J1u k l)'(Jsl00r1I de l c.'.!errblo(. role ('r.-el 1.t' ·.-olo fc-,Oloble 6 fodopto, de P,Ofl!i e resok•tcr. pre-5en!f.?s OU 03re,e! PJf :,e CO!"!iel-l door,n.:,!r:;!,o, OIJ 1 Cf·1ecXHP. bn I C-0 et un ·11,1e, de!o-.-o1;1 ol'odopt·X. do ro..s !t ovfres p,- oo rPo.;r (-rrce 11.. t o.: re r.Je 'o·,orino 1e 00.1 la re , ho, · a. oc do:" ·.-oie- dom Ito 1'Yln.. '- par It, mQrOO",( 1----------------------------------J | Iel,r!oc-.Tie per !,On mondo'o.re de to/ fo,1 l.,1 oerrr1;" ;; .1 de rr,e,urt- le n:.qul! que ceoem,er IX)J;.U ,'!un 1no.l,1 Q;_•'re que le ,..,,, Cete ,dOfmc':.::in por!t) no*o-nrr,or.: !.I.Jr le lo Io;.,e ic mo-"00u1·L' OIJ le co!t ochoor,t. lo porv.,nnc pour cooor di.:' .,Jq.;-el I 091 . 1• C:O"·". cu n} :Je l'n1,ce •. 'i'3l3 la 'o'.'iete d.Y,I ro .'..b:oo ru: apt.......!.oe Cl 1£>!JM 2.· 1 mcmbrc, oo .:,:?=r,e 00 g:,on. d'ad.,-,1:,is.ra•ion OIJ d1: ur..e-dorice de ce1e Y.lC"'* oo o lr,e r>c,or,ne 01 1 b | ||
on":Q oJ s.t::t".id>:" r:'l.--1!:' I 233·3 (41 POUVO!R A UNE PERSONNE DENOMMiE 3' E,1 e«,plo, r,:::, ,.,.1()(€1 ()(J P:.:' ,",,,,,r,n q,, lo :.en.1 i:k IC"« I 233-341E!.1 controlo 0.1 hCe IJJfttJ s. f.y.._1,.or1 mer,:,Of,nec:. au 2• OJ O.i 3 dam ur.c pc-r:.c ou tt' er,t 10 co-.:: pcr. Ait,cle l 225· 1C6 de Code de Co· ce ,"" ' ',, une Det,:;e qui conrolt- lo i!e. O'J !ier".i de lc·hdo? l 233-3 1 Un oc1oona,:!"X1, so •o,re ·ept't-nr 001 L•n O..;'lfe oc ,onno:·e, po· s.c,r1 conioin1 ou po le por!e--c,·e o -..:q...el 11a condu un j»:1e cr,,1 do? ·!':" (ei,e :-Jorrro"1f)n e-5'e-3obnent .>:'k,.rf'.""• lor ;_;,1 f.•1:,.I ..,..1,en b·1i1:;;!1-'f. e le "'ll)'l(fo!:l r" w, le, ("(hf..:)"I! kl flfr+fle' pou1 P! c,.yi,pt,:o d-:? oo.,elle .!cg I C'! ,s,e s.orine {•J",JC pxft: d1r! 1 ....-.? :i.:'s. s.1,¢1,:.ns er;:,.....,e·f.es au, 1° !lA0 p.;;.rl "!rt o..1re f,'J re 1epre1..1:nter p:,• 11.JV!e out·e r:rq.l)i> ph,.:.,,1.ie Cu ll'O'O dP. cho ( l,:irsq,J co ccot.1r!. d,:-,...,anda·. >ur t I ..rHJCS lo me:Jui o 1fi-::! p '(ecienh E moocbtoe ,;l.y-ie ! 1• lo, l.:.i 01/¢fl) de h $oot,r Sl.'lt'l odmi au, "w, uo modi!! rcgerr.cn e . 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(2) VOTE PAR CORRESPONDANCE Av · . !]5 107 d,_ C-.o o (ornrr, •rce f• •dro1°! lo_• o.:. 1onno re pt.,.1' 'Npar ..,·:v:,poridon0.1 'nd vn f,:;.r,.,vlo e ,! trie('.'.1ons w,1l,.t.,e P'l' d«ef · C.0,,.)ei d ;1n1 lf c..,po: ,·,on cc,,!101:t".'1 d• 1:.-.a .m ·ri". Pl,lie'e l"lO'! ec·ite P: ::oL:vl du qL.-:. -:-i, ,In e-'1 'eni.1 coo,pli:G-'"" •.>!$ f,}frr,vh· s q,:• or1! t 1...;i,..;o ;:.Y l,1socilo rei.r,,on do c :£of".:)ICO, do1l les cond·,ons de de.,J s , .es PY deer n Cor..:-d Eto1 I, I, ,lo··es r..:-1 dor,non.: oucun !L'r1 de 01e eio e•¥1mc.-;I 1Jre oC/'enl:O",)Ofl! CO"',s1de.·es corr-!"lf.? des vote,- ni:s ·· • c ·nJ,00•e.: ·,'Oler ;J11r co,1ttp.Jrl·1t'l(tl, ·.-'C')J1 !•lo Dr·, C(> en•. , ,i;':':J ;_f.00
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FORM TERMS AND CONDITIONS
(11GENERAL INFORMATION TI- , ,1 p. Ll 'O Ar , , 72570 do Code ooCur.,rr(.or.:,:? ·h,die.'N oc,.::,i u 1he s.1gn:::1.r., sho, -.:I •"'...: hl, 1-f,..r1rJ ,..OITI'! and fl(.Xj f-- in cop1tal lier, n e pre,. t? :J O l g Jt:10" :o-c. l".:'IJO i "'J ff Jl.)1l"ll)'On l>.JJittl l,.! ni.l'1ie:·d u 1eM·1 .:u•oo re chJ. C:Y• be mo> u 1r,g th,s :to...,, "Ol';or'I'. • !he 3,&.1t',' .so ·-:go! t""l•J,., r,- h:Aild d:,)her fJ r.::i.ne or.1 !tit;' CClC.1i ,., .......(. , b1? s er,: .!'J t ..; on ·YJ! en• r,· oc .. " lti0 !.l:f•::,.:.V, ·l"(_f me- !.'.x1'l vio_y :c-g a k"']OI g..orc,or.1 please !pee, ·r.,,s bJI rie-rie :rd ,..,r: ec:::»:1 r; .1,h.d, '(.>,. oie 11']1'1 - '] •"':' p-( I.'...... ""1m 5il;'r,I f,)f Cz n:],•018 r- ·,"Jl,j let nll n°E'!'f J" •l,!..!'-1· cm,«.1,·,+i the rTie o:p-iOO IAt:c.le 225'1, ol,nec J ,JJ Cooe ():, Cor.met,e: TI--,c, ):,' · the fe.'.o!iPor.:. ,, ,.... ?",e no',fic::J11Un oi frle ''.'II) Atd1 · !oef.t w1!h '""1f r.,-1 (A:•1::le 225-81 di1 CocJt: ri C tr,l"'CE!-I P(-c;.e d;, nof u !:dii,,:,e b, po-.;" .::.. E-Dv 1rl iA.-,de" ..25 S 1 a·J Coded (CATtrl!'fce) iht ' •r,:h ,,i I'1 ,J,. ,,. ,. I •fri!o, nl(, ln·t!i'• 1: ·.ct'i I!. ..:1 {O,,· {'O!e."C:e oril,- | (3) PROXY TO THE CHAIRMAN OF THE GENERAL MEETING Art.c L 225·1Coo_· ...,.-: (c...,ceie,t-o,:rl ·1n 11 '! · :,e ct :;- , p'l,....._'f J r,:p.:'::':,,r,1:;:,, ,r, :Ja«• h1,o .:,h()ff'hr.,.:M "'.+......_• ......,ir19 0 f'(( '1. It ,:hiMTw)I'! cl t-.o 9',"-lfle'rl! rr,e,et,""3 :t-o!.,J r.ft!'" b"1:I,::,. oo)fJh a dr:,i r,:..oli/.lor.:. :,..,:,r.l'leoJ or opoo...d C'· !he Sc,;yd LL! i>.·ectJrl c,r lhe ..on-.>r-1?' b:tJ•d Irie Cesl' l'!"C:, h • ,J--id,J ,•:t,.:, D?O '"I!.' od:..ctrn on; Ol'f c·a w.Ji/'Yi . ki .:.Su(' a., c+l('I .,c.1 ti"ie .-y,;;..!Je( ""IU'.1 opp:v,1 o :._,.,ho og·.· ;:; tO>e in ·--.e rT"l,..oer ,jOJ'W t,, h, r .·,PJ- | ,•.,th, he-:,, V--: •! .r,f.·, oed b,, "tie 'fl'=-:l of "Jrr1 t","f!r;' eri.JL. ng h r""·o, ht-1 "rn':"'.nu:µ ,...e w: rh:;·•!''":." J p.,r.·-'Y1 ·11·: 1!h« li-.;"l h Ihe1:. ·n !, ,n."om,J'.On e,b,e n p:)1'! :vc: : :1-ie .e, r ,ot ! P '.J(r·..,., O!. t",e O::.il ITH1' 00 It--. pe,,:,-.er, :,efolof.,"t ocr. Corh:ib, .-.·1iri. be mron·n;3 J o,.,· l (.33·3 I'".(! eo,r,pol""-f ·"""'»e g· .:..il ,:.! 'J ho-, f!tlF.11 2 I• r,-,embo: c !r.e rr.:,nog,-:'Tif"...,! bootd ad-, n •)ra•.,-,., r- uper,.,:,0,•; Coo:d c.i r-e coo·por·y r:, a pc1"" · .-.h;ch 1....,.,ft, n I!">:! r""'r·•"•::; d .,1:d°"' l 233·3 |
(41 PROXY TO A MENTIONED PERSON (INDMDUAL OR L£GAL ENlTTYJ ,:; empc,,(d Di '!!"it" co-;,-.:,.• C perri .·-.h:d•. ccr :c,b • ....;"',1 l"",e rr,,::,n,rq ct Q:"'i,:,e l 23J) .....,oi'leo:! •.: · orr1E'.' ot,! cne rt:o: f.:_....4.. -,"IS r,-,e.•:Cf"led'Iv •·,:-,e 2 Of °"·3°1!1 v ::>:'f"Y" OI :::,n fer+ •1· ry-,!':,.::.ed A11-·!.c I '}]').. 1 ".o r. .- , 1rr, ,·p .trao1 tr-, r}C(:... c y,1,ol: l'",e .:orq]()r:,. .,it+ n -'if'I 11oJ c.f ,: :.c.1-1 . 233 3 "'1e()r'I be·ep·eleO ':Jy o-.:,•her ;...",:irokk, o, .-,J or '";e =XA.:.o.: a bi h;s v·h::· ;:cw.er .,,ho he Th,,r. ma1.;.)0 :. obc did ..:·100 .....h,-r, o brr·- ¥c tJ, :... b:>r.-.(IC',lr.o pc)! m·'-ie C;J-,,J·1; ::-u +ie .- , :,.., , /.. :.hcl'ehdder ,. c,1y,._."vn en.!i(;i.;i,-l ,ro:.;> o .-11 ui,; in ,,.,.:11 [J(lhaK d ,..t,crr, ,io,:•:.. l)nd c no·. ·tll r,c!:u, pbcro n one Cl Ir.I'.! 5.1"..ct.or•!t ('"" •me'o°OO l·"O"" 1" ii.::i .!" ,;:,:_.·,t> HeC•t !.he CC!"'! ,:::i'$0 [: re-p-..,er;•ed Ct)' C'1 1 ,e,dJ.ol c1 _;ia' ('r/ tf cf h.s r rer r:1--:,,;.:e /'iher1 du-.,g ....2 c,i,::,,i or:.: o! +,,,e,,e,-•;1 m::t.onil:IC .,.. "1.e proceci ng .oooiagro:-x.•.occi.:·:.:- f··c.-,. 1,Y"'U ...-. ::-o;.;1 '''t t'°r1en If'-: s.tiart>.s a·'! 'J+ru-te,.j to roding fY"o C ru! J ITC! ':'! :i ;c..1:i! 1Jf:!,1 FoJ, J t,l r-l.r ti c··.L:m e•;t'!'_r'.-f l'"'ie pc·, ·h1) o."'le s n.:!I o J 1 Th., lt-• 1r..;:'.7, ,::J 2'.'·V"'tf!f', '..'"l"JIM fl1 ndn-1 :!(d 1v Md or, o ...J!.1o"l! ::al 1oj1"'9 trx:,11•, 'A"t.ic"'- ,, wb«" () !ho J!01!.a..d m..:, ,:f-, r 1.5, r.c..,?...e,,J ·1. ti,,) Ot'.!lo, r,f lt-0 pto,, :..>·i-,o c·::mpa", 1egJat,:,r., p-0,·1!· .) !:"ol prole-:t. 1r-· o:!,Jrs ·:>30,r. 1 ni,>?f ,n?orma:,on pr··-::e mJn pula·:iri. rr,d Ois.:.e!T '".cl y d•o'.51: r ccrd1t.l(,r do;.-·:·11, ,on ci ,rlis orf-:le c:e '!"! ne-:f !,;;, cY! ,:, tto·oeo . 1r..!o,m11•,on n, oio-....1--d l-)' 1h.:, '.',r!5'rero: ,eg ·lolon of ·..- .A.,.l..)r11! des rro,1;:hcs !rv1x,er:., ,:f1W!..,l"." • 1. 225-10:":..2 /'j,, ' v..d".' ( .-·-von:_. c,g1.•lo•o·-.,. 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{21 POSTAL VOTING FORM A:•, L :_> i. ;J7 ·=- Co:>. ., CO""rrll'fce . '•JH·1 .JJ ie con -'-: ,p7.' L)· °!'n(l -:: p:r..t,Jl ,..-J n11orm d,e:m1r-,ed t:•y (rr.5,1!:I,iEt:i• dee '-'!:: An·,CJ"ll.;'f meod, ,) l' &,c,""Nd "> b·:!' ir. ·d • .. · On. i 1u.:, f,:rm!. iei,P,l t-,, ri.e(..QfflPJ:Tt ·:b-,·1he,V.._.:,t;ri:1 .•.""' ,!tie!, l,,il 1,;l'lil (;.O"C.!..)!"o).Jt".'°f.'rm"t•d h; C.•"'IY. d Eto decee. ore, ·.-::d lo ca,:uble tie chum Tl-,e I )f""'"I 9..,...,1n·· r.r,g a,:t:-:'t,:;(I Of n,l:co"1r:3 ?b·.!.....-.!,C)I; ore d.("J ) -"n.-.• •If ·, ...·.:.h l' u:e rr.e ).: 1 .,.-:: ") f.;,m ,•. -.:, hue l,J t.oj h :,- l"'.e 4 ·or1!} "'"ieo d,.-_uTJer,· ·1 ,r?ti b-1 ,···!"" · uch e·.-er.t c,leo:.e ccrro.•; '"'-... :he I,:,,. ,-.·;ng 1" ·:n, 1..ys • F,:.i '":' 'eh" ·.."'•1.."nS pi:: :.ec JI Ott, !"',e e- ·v ''fOO ;.,.; e·f.et>v •y(••/ f,-y 01 m,1,. ,'L}.u ;;1'4 O'; .,'!'1 ffle OO.-e1 bl:,n,, f.7 'Cle 'rr/ ,:,r ",::b 11.:.,-.. ·1.·-.;.,·, _h ,_,, eq·J :l'Jen:k -.1:te "n.i:J -::y hod, , b, ,:. .:/ ,'OJ' choce
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