Proxy by Member of Company by Shiva.

Proxy by Member of Company

. . . . . . . . (Name of Company)

We . . . . . . . . of . . . . . . . . in the district of . . . . . . . . . . . . . . being

a member

————of the abovenamed Company hereby appoint. . . . . . . . ?members

of . . . . . . . . . . . .in the district of . . . . . . . . . . .or failing him. . . . . . . .

my                     ??     me

of . . . . . . . . in the district of . . . . . . . . . . .——proxy to vote for——

our                    ??      us

my                        ?    annual general meeting

on—————behalf at the———————————(not being an ???our                        ?         general meeting

annual general meeting) of the Company to be held on the . . . . . . . day of . . . . . . . . and at any adjournment thereof.

Signed this. . . . . . . .day of. . . . . . . .

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