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"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 form in a manner that would substantiate your eligibility for an exemption
their authorized representatives to exempt you from Israeli withholding tax. ART I 1. Name: Identification and details of Shareholder (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 Co
"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 form in a manner that would substantiate your eligibility for an exemption
their authorized representatives to exempt you from Israeli withholding tax. ART I 1. Name: Identification and details of Shareholder (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 Co
"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 form in a manner that would substantiate your eligibility for an exemption
their authorized representatives to exempt you from Israeli withholding tax. ART I 1. Name: Identification and details of Shareholder (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 Co
Entities connected to both Mobileye N.V. and Eligible Israeli Brokers