EX-99.5 6 dp56142_ex9905.htm EXHIBIT 99.5
 
Exhibit 5

POWER OF ATTORNEY
AGM AFFIMED N.V.
JUNE 9, 2015
(FOR LEGAL ENTITY)

[insert full name], a legal entity organized and existing under the laws of [insert country], with its corporate seat in [insert name city], having its offices in [insert address], [with DTC participant number: [●]]1 (the "Grantor") herewith grants a power of attorney to (please check the box that is applicable):

________________________________________ (possibility to include name of authorized person)
 
each of Michael Wolf and Eva Suendermann, both retained by Affimed N.V. (as  defined below) (each a "Company Attorney"),

(the "Attorney"), to represent the Grantor, as shareholder of Affimed N.V., a limited liability company (naamloze vennootschap) organized and existing under the laws of the Netherlands, with its corporate seat in Amsterdam, The Netherlands, with address at Im Neuenheimer Feld 582, D-69120 Heidelberg, Germany, registered with the Trade Register of the Chamber of Commerce under file number 60673389 (the "Company") at the Annual General Meeting of Shareholders of the Company to be held at Hilton Amsterdam Airport Schiphol, Schiphol Boulevard 701, 1118 BN Schiphol, The Netherlands, on June 9 2015, at 15.00 hrs. (CET) (the “General Meeting”), and (i) to exercise in the name of the Grantor at the General Meeting any and all voting rights attached to the shares in the capital of the Company which were held by the Grantor at the record date of the General Meeting (May 12, 2015) and (ii) to vote all shares held at the record date in favor of the proposals as stated in the agenda for the General Meeting unless stated otherwise below:


1
If applicable, please include the DTC participant number and provide the omnibus proxy granted by DTC to the Company.

 
 

 
 
Agenda item 4
Discussion of the 2014 Statutory Annual Report and proposal to adopt the financial statements for the financial year 2014, as prepared in accordance with Dutch law

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Against
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Abstain
  o   o   o

Agenda item 6
Discharge of the managing directors for their management during the financial year 2014

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For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 7
Discharge of the supervisory directors for their supervision during the financial year 2014

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 8
Appointment of a new supervisory director: Mr. Ulrich M. Grau

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 9
Appointment of the auditor for the financial year 2015

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 10
Authorization to acquire shares

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For
# Shares
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Abstain
  o   o   o


 
 

 
 
Each Company Attorney, if authorised pursuant to this power of attorney, may grant a power of attorney to another person employed by the Company to perform, directly or indirectly, acts in Grantor's name within the limits of this power of attorney. The other person shall (also) be an Attorney for the purposes of this power of attorney.

The Grantor undertakes to ratify or confirm anything which the Attorney shall do or lawfully purport to do by virtue of this instrument, and shall indemnify the Attorney and keep the Attorney indemnified against and shall reimburse the Attorney for any costs, losses, suits, claims, demands, obligations, liabilities and damages which he may suffer or incur arising out of the exercise of his powers pursuant to this instrument.
 
 
Finally, the undersigned hereby represents and warrants to have full power and authority to execute this instrument on behalf of the Grantor, and that pursuant to this instrument the Attorney can validly represent the Grantor.

This power of attorney shall be governed by the laws of the Netherlands.

- Signature page follows -

 
 

 
 
Signed in __________________________ on _  _________________, 2015.

__________________________________
 
 
Please fax or email a copy to:
Affimed N.V.
Attn. Michael Wolf
faxnumber: +49 62216530777
email: m.wolf@affimed.com

Please mail the original power of attorney to:
Affimed N.V.
Attn. Michael Wolf
Im Neuenheimer Feld 582
69120 Heidelberg, Germany
 

 
 

 
 
POWER OF ATTORNEY
AGM AFFIMED N.V.
JUNE 9, 2015
(FOR NATURAL PERSON)



[insert full name], having its address at [insert address + country] (the "Grantor") herewith grants a power of attorney to (please check the box that is applicable):

________________________________________ (possibility to include name of authorized person)

each of Michael Wolf and Eva Suendermann, both retained by Affimed N.V. (as defined below) (each a "Company Attorney")

(the "Attorney"), to represent the Grantor, as shareholder of Affimed N.V., a limited liability company (naamloze vennootschap) organized and existing under the laws of the Netherlands, with its corporate seat in Amsterdam, The Netherlands, with address at Im Neuenheimer Feld 582, D-69120 Heidelberg, Germany, registered with the Trade Register of the Chamber of Commerce under file number 60673389 (the "Company") at the Annual General Meeting of Shareholders of the Company to be held at Hilton Amsterdam Airport Schiphol, Schiphol Boulevard 701, 1118 BN Schiphol, The Netherlands, on June 9 2015, at 15.00 hrs. (CET) (the “General Meeting”), and (i) to exercise in the name of the Grantor at the General Meeting any and all voting rights attached to the shares in the capital of the Company which were held by the Grantor at the record date of the General Meeting (May 12, 2015) and (ii) to vote all shares held at the record date in favor of the proposals as stated in the agenda for the General Meeting unless stated otherwise below:

 
 

 


Agenda item 4
Discussion of the 2014 Statutory Annual Report and proposal to adopt the financial statements for the financial year 2014, as prepared in accordance with Dutch law

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 6
Discharge of the managing directors for their management during the financial year 2014

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 7
Discharge of the supervisory directors for their supervision during the financial year 2014

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 8
Appointment of a new supervisory director: Mr. Ulrich M. Grau

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 9
Appointment of the auditor for the financial year 2015

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o

Agenda item 10
Authorization to acquire shares

# Shares
For
# Shares
Against
# Shares
Abstain
  o   o   o


 
 

 
 
Each Company Attorney, if authorised pursuant to this power of attorney, may grant a power of attorney to another person employed by the Company to perform, directly or indirectly, acts in Grantor's name within the limits of this power of attorney. The other person shall (also) be an Attorney for the purposes of this power of attorney.

The Grantor undertakes to ratify or confirm anything which the Attorney shall do or lawfully purport to do by virtue of this instrument, and shall indemnify the Attorney and keep the Attorney indemnified against and shall reimburse the Attorney for any costs, losses, suits, claims, demands, obligations, liabilities and damages which he may suffer or incur arising out of the exercise of his powers pursuant to this instrument.
 
 
Finally, the undersigned hereby represents and warrants to have full power and authority to execute this instrument on behalf of the Grantor, and that pursuant to this instrument the Attorney can validly represent the Grantor.

This power of attorney shall be governed by the laws of the Netherlands.

- Signature page follows -

 
 

 



Signed in __________________________ on _ _________________, 2015.

__________________________________


Please fax or email a copy to:
Affimed N.V.
Attn. Michael Wolf
faxnumber: +49 62216530777
email: m.wolf@affimed.com

Please mail the original power of attorney to:
Affimed N.V.
Attn. Michael Wolf
Im Neuenheimer Feld 582
69120 Heidelberg, Germany