Proxy for Voting for or against a Resolution by Shiva.

Proxy for Voting for or against a Resolution

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

I

—— . . . . . . . . of . . . . . . . . . in the District of . . . . . . . . . . ., being

We

a member

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

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

my

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

our

me          my                         annual general meeting

—— on —— behalf at the————————————(not being an

us          our                  ??     general meeting

annual general meeting) of the Company, to be held on the. . . . . . . day of. . . . . . . ., 20. . . . . . . . and at any adjournment thereof.

Signed this . . . . . . . . day of . . . . . . . ., 20 . . . . . . . .

This proxy is to be used in favour of the resolution; unless otherwise instructed the proxy will act as he thinks fit.

NOTE: Strike out whichever is not desired.