INSTRUCTIONS FORMING PART OF THE DECLARATION OF STATUS FOR ISRAELI INCOME TAX PURPOSES I. General Instructions. This Declaration Form (Declaration of Status for Israeli Income Tax Purposes), or this Form. should be completed by holders of Shares who wish to tender their Shares pursuant to the Offer, and who are either: (i) Non-Israeli Residents: (I) hold less than 5% of the outstanding Shares of Mobikye, (2) NOT "residents of Israel" for purposes of the Ordinance (See Instruction II below), and (3) DID acquire the Shares tendered on or after January I, 2009; or (ii) A Bank. Broker or Financial Institution Resident in Israel: a bank. broker or financial institution that are "residents of Israel" within the meaning of that tenn in Section 1 of the Ordinance, that (I) is holding Shares solely on behalf of beneficial shareholders) who holds less than 5% of the outstanding Mobileye shares and acquired his Mobileye shares on or after January• I. 2009 (so-called "street name" holders), and (2) is subject to the provisions of the Ordinance and the regulations promulgated thereunder relating to the withholding of Israeli tar including with respect to the cash payment (if any) made by them to such beneficial sharcholder(s) with respect to Shares tendered by them and accepted for payment by Mobileye pursuant to the Offer (an "Eligible Israeli Broker"). NOTE: AN ELIGIBLE ISRAELI BROKER MAY COMPLETE THIS FORM IF IT IS HOLDING THE SHARES SOLELY ON BEHALF OF HIS CLIENTS, THE BENEFICIAL SHAREHOLDERS. Part I (Identification and details of Shareholder, including Eligible Israeli Broker). You should complete Item I. 2 and 5 through 8 and either (i) Item 3, if you are an individual, or (ii) Item 4, if you are a corporation (or limited liability company), mist, partnership, bank broker, financial institution or other entity. If you hold less than 5% of the outstanding Shares of Mobileye, you should complete Item 9. Part II (Declaration by Non-Israeli Residents). If