Genoa-style Takeover

Filling in this form I want to be represented by Mr. Beppe Grillo at the next Telecom Italia spa's assembly, company of wich I am a shareholder.

Name:
Surname:
E-mail:
Personal tax code:
Number of shares:
Privacy policy (D. Lgs. n. 196/2003)*
I have read the policy and give my consensus.
*compulsory fields