(Commission File No. 1-14862 )
Indicate by check mark whether the registrant by furnishing the information contained in this Form is also thereby furnishing the information to the Commission pursuant to Rule 12g3-2(b) under the Securities Exchange Act of 1934.
Yes ______ No ___X___
Last update: 03/29/2018
DISTANCE VOTING BALLOT |
Extraordinary General Meeting (EGM) - BRASKEM S.A. to be held on 04/30/2018 |
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Shareholder's Name |
Shareholder's CNPJ or CPF |
Instructions on how to cast your vote This remote voting form (“Voting Form”) must only be filled out if the shareholder of Braskem S.A.(“Company”) decides to vote by remote voting, pursuant to CVM Instruction No. 481, dated as of December 17, 2009, as amended (“CVM Instruction 481/09”). In this case, it is necessary that thefields above are filled out with the complete name (or corporate name) of the Company´sshareholder (“Shareholder”) and its Federal Taxpayer’s Registry (CNPJ) or Individual Taxpayer’sRegistry (CPF), as well as an e-mail address for eventual contact.
In addition, in order for this form to be considered valid and the votes recorded herein counted inthe quorum for the Extraordinary General Meeting (“EGM”), the following instructions must beobserved: • All fields must be duly filled out; • All pages must be initialized; and • At the last page, the shareholder(s) or it(s) legal representative(s), as the case may be and inaccordance with the applicable law and regulation, must sign the Voting Form and signaturenotarization will be required. |
Instructions for sending your ballot, indicating the delivery process by sending it directly to the Company or through a qualified service provider
The Shareholder may transmit the instructions for filling the Voting Form: (a) directly to theCompany (Rua Lemos Monteiro, No. 120, 22nd floor, Zip code 05501-050, São Paulo, SP, c/oRelations Investors Department and/or by the e-mail braskem-ri@braskem.com.br, requestingreceipt confirmation); or (b) to service providers who are able to provide services for collecting andtransmitting instructions for Voting Form purposes, such as: (i) the Shareholder custodian agents,if the shareholders’ shares are held in central depositary institution; or (ii) to Itaú Corretora deValores, the financial institution hired by the Company to provide bookkeeping services for thesecurities that are not in central depositary institution (Avenida Brigadeiro Faria Lima, No. 3.500,3rd floor, São Paulo, SP, Zip code 04538-132 and/or by the e-mail atendimentoescrituracao@itauunibanco.com.br, or by the website http://itau.com.br/securitiesservices/assembleiadigital / Phonenumber for the attendance of Shareholders: + 55 (11) 3003-9285 (capitals and metropolitanregions) or 0800 7209285 (other locations))
The shareholder who desires to exercise its voting right by sending the Voting Form directly to theCompany, pursuant to item (a) above, must send the following documents, requiring notarizationand consularization or application with certified translation (in case of foreign shareholders), as thecase may be, to the Company: (i) Voting Form duly filled out, with all pages initialized and signed(not being possible to be signed by digital certificate) with shareholder signature notarization; (ii)proof of the Company’s shares ownership issued by the custodian institution or by thebookkeeping agent of the Company, depending on whether its shares are deposited at the centraldepositary or not and, in case intends to exercise the right set forth in article 144, §§ 4 and 5 ofLaw No. 6.404, dated as of December 15, 1976, as amended (“Brazilian Corporate Law”), theshareholder shall attest the nonstop equity capital for a period of, at least, three (3) months prior tothe EGM; and (iii) copy of the following documents:
• Individuals: personal identity cards with photo and taxpayer registry document (CPF) of theshareholder (and, in the case of an attorney, a power of attorney with signature notarization, aswell as the documents above of the attorney);
• Legal entities: documents of constitution or articles of association or Bylaws, minutes of themeeting which elected the Board of Directors (if available) and minutes of the meeting whichelected the Executive Officers containing legal representation rights for representative(s) withrepresentation rights to attend the EGM, as well as personal identity cards with photo andtaxpayer registry document (CPF) of the legal representative(s) of such company, and, in the caseof an attorney, a power of attorney with signature notarization, as well as the documents above ofthe attorney; and
• Investment funds: fund regulation and Bylaws or articles of association of administrator of thefund, as well as the minutes of the meeting that elected the legal representative(s) withrepresentation rights to attend the EGM, as well as personal identity cards with photo andtaxpayer registry document (CPF) of the legal representative(s) of such fund and, in the case of anattorney, a power of attorney with signature notarization, as well as the documents above of theattorney.
The following identification documents will be accepted, so long as they have a photo ID: identity |
DISTANCE VOTING BALLOT |
Extraordinary General Meeting (EGM) - BRASKEM S.A. to be held on 04/30/2018 |
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card (RG and RNE), driver’s license (CNH), passports and professional class entity cards that areofficially recognized as such.
In accordance with CVM Instruction 481/09, the Shareholder must transmit the Voting Form fillinginstructions to the custody agents no later than seven (7) days prior to the EGM that is, until April30, 2018 (this day included). Any voting forms received by the Company after the date will bedisregarded.
If the Shareholder choose to exercise its voting right by sending the Voting Form through theirrespective custody agents, the Shareholder must contact directly such institutions to verify theprocedures established by them for the issuance of the instructions on the Voting Form, as well asthe documents and information required to do so.
In accordance to article 21-U of CVM Instruction 481/09, the Company will inform the Shareholderthat send the Voting Form up to three (3) days of the delivery of the Voting Forms, if thedocuments received are satisfactory to the requirements for votes considered valid or, ifnecessary, the procedures and deadlines for eventual rectifications or resend of the Voting Form,noting that such rectifications should be done in up to seven (7) days prior to the EGM, that is, byApril 30, 2018 (this day included).
It should also be noted that the Company’s Management Proposal containing the documentsprovided as in articles 9, 10 and 12 of CVM Instruction 481/09, is available to Shareholders at theCompany’s headquarters (Rua Eteno, No. 1.561, Polo Petroquímico, Camaçari, Bahia), in itswebsite (http://www.braskem-ri.com.br), and at the website of Brazilian Securities and ExchangeCommission (Comissão de Valores Mobiliários) (“CVM”) (www.cvm.gov.br). |
Postal and e-mail address to send the distance voting ballot, if the shareholder chooses todeliver the document directly to the company
As mentioned on item above (“Instructions for Delivery”), the Shareholder must send the VotingForm to the following address: Rua Lemos Monteiro, No. 120, 22nd floor, Zip code 05501-050,São Paulo, SP, c/o Relations Investors Department and/or by the e-mail braskemri@braskem.com.br, requesting confirmation of receipt. |
Indication of the institution hired by the company to provide the registrar service ofsecurities, with name, physical and electronic address, contact person and phone number
As mentioned on item above (“Instructions for Delivery”), the Shareholder must send the VotingForm to the following address: Avenida Brigadeiro Faria Lima, No. 3.500, 3rd floor, São Paulo, SP,Zip code 04538-132 and/or by the e-mail atendimentoescrituracao@itau-unibanco.com.br, or bythe website http://itau.com.br/securitiesservices/assembleiadigital.
The phone number for the attendance of Shareholders is + 55 (11) 3003-9285 (capitals andmetropolitan regions) or 0800 7209285 (other locations), and Mr. Marcio Conde Souza is thecontact person. |
Resolutions concerning the Extraordinary General Meeting (EGM) |
Simple Resolution 1. Resolve the amendment of article 4 of the Company’s Bylaws due to conversion of shares byminority shareholders of class “B” preferred shares.
[ ] Approve [ ] Reject [ ] Abstain |
Simple Resolution 2. Resolve the inclusion of paragraphs 1, 2 and 3 in article 18 of the Company’s Bylaws to predicta minimum percentage of 20% of independent members of Board of Directors.
[ ] Approve [ ] Reject [ ] Abstain |
Simple Resolution
3. Resolve on the amendment of the Company’s Bylaws to include a Compliance chapterproviding for the creation of a statutory Compliance Committee and the formalization of theexistence of a compliance area in the Company.
[ ] Approve [ ] Reject [ ] Abstain |
| DISTANCE VOTING BALLOT |
| Extraordinary General Meeting (EGM) - BRASKEM S.A. to be held on 04/30/2018 |
City :__________________________________________________________________________ |
| Date :_________________________________________________________________________ |
| Signature :_____________________________________________________________________ |
| Shareholder's Name :____________________________________________________________ |
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
Date: March 30, 2018| BRASKEM S.A. | |||
| By: | /s/ Pedro van Langendonck Teixeira de Freitas | ||
| Name: | Pedro van Langendonck Teixeira de Freitas | ||
| Title: | Chief Financial Officer | ||
This press release may contain forward-looking statements. These statements are statements that are not historical facts, and are based on management's current view and estimates offuture economic circumstances, industry conditions, company performance and financial results. The words "anticipates", "believes", "estimates", "expects", "plans" and similar expressions, as they relate to the company, are intended to identify forward-looking statements. Statements regarding the declaration or payment of dividends, the implementation of principal operating and financing strategies and capital expenditure plans, the direction of future operations and the factors or trends affecting financial condition, liquidity or results of operations are examples of forward-looking statements. Such statements reflect the current views of management and are subject to a number of risks and uncertainties. There is no guarantee that the expected events, trends or results will actually occur. The statements are based on many assumptions and factors, including general economic and market conditions, industry conditions, and operating factors. Any changes in such assumptions or factors could cause actual results to differ materially from current expectations.
