4
Shared Docs
4
Same-Page
4 / 4
Mentions
X in the appropriate O directly, as a Registered Holder O through a Broker. If you marked this box, plea
"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
X in the appropriate O directly, as a Registered Holder O through a Broker. If you marked this box, plea
"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
X in the appropriate O directly, as a Registered Holder raihrough a Broker. If you marked this box, plea
m "Declaration of Status for Israeli Income Tax Purposes" as a holder of Ordinary Shares, nominal value €0.01 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
X in the appropriate O directly, as a Registered Holder O through a Broker. If you marked this box, plea
"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
Entities connected to both Eric Holder and Mobileye N.V.
Mobileye
ORGANIZATIONK Corporation
ORGANIZATIONOrdinary Shares
ORGANIZATION
Nintendo
ORGANIZATION
New York Stock Exchange
ORGANIZATIONNon-Israeli Residents
ORGANIZATIONEligible Israeli Brokers
ORGANIZATIONK Bank
ORGANIZATION