Proxy under Societies Registration Act by Shiva.

Proxy under Societies Registration Act

I, A.B., son of . . . . . . . . . . ., of . . . . . . . . . being a member of this . . . . . . . . Society and entitled to vote do hereby appoint C.D., son of . . . . . . . . of . . . . . . . .to be my proxy to vote for me and on my behalf at the (ordinary or extraordinary, as the case may be) general meeting of the Society to be held on the . . . . . . . . day of . . . . . . . . and at any adjourned meeting thereof.

In witness whereof I have set my hand hereunto this . . . . . . . . day of. . . . . . . ., 20 . . . . . . . .

Signature

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