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.