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ly by Non-Israeli Residents and Israeli Brokers.) You arc receiving this form "Declaration of Status for Israeli Income Tax Purposes" us a holder of Ordinary Shares, nominal value €0.011 per share, per share (the "Shares") of Mobileye N.V. (the "Company"), in connection with the tender offer. By completing this
lder (including Eligible Israeli Brokers) (see instructions) 2. Type of Shareholder (mom than one box may be applicable): (please print full name) K Corporation (or Limited Liability Company) K Individual K Trust O Partnership O Other K Bank O Broker O Financial Institution 3. For individuals only:
ly by Non-Israeli Residents and Israeli Brokers.) You arc receiving this form "Declaration of Status for Israeli Income Tax Purposes" us a holder of Ordinary Shares, nominal value €0.011 per share, per share (the "Shares") of Mobileye N.V. (the "Company"), in connection with the tender offer. By completing this
lder (including Eligible Israeli Brokers) (see instructions) 2. Type of Shareholder (mom than one box may be applicable): (please print full name) K Corporation (or Limited Liability Company) K Individual K Trust O Partnership O Other K Bank O Broker O Financial Institution 3. For individuals only:
ly by Non-Israeli Residents and Israeli Brokers.1 You arc receiving this form "Declaration of Status for Israeli Income Tax Purposes" us a holder of Ordinary Shares, nominal value €0.011 per share, per share (the "Shares") of Mobileye N.V. (the "Company"), in connection with the tender offer. By completing this
lder (including Eligible Israeli Brokers) (see instructions) 2. Type of Shareholder (mom than one box may be applicable): (please print full name) K Corporation (or Limited Liability Company) K Individual K Trust O Partnership O Other K Bank O Broker O Financial Institution 3. For individuals only:
Entities connected to both Ordinary Shares and K Corporation