APPOINTMENT OF PROXY
I,
(Insert MEMBER’S name)
…………………………………………………………………………………………………
……
(Insert MEMBER’S address)
Being a member of …………… …… ……… …… …… ……… …… …
(Insert name of INCORPORATED ASSOCIATION)
APPOINT
…………………………………………………………
(Insert PROXY’S name)
Who also is a member of the Association, as my proxy?
My proxy is authorized to vote on my behalf: (Tick þ only ONE of the following)
¨ at the general meeting/s (and any adjournments of the meeting/s)
On ………… (Insert relevant date/s)
OR
¨ In relation to the following resolutions and/or nominations
In favor: Against:
……………………………………………………
……………………………………………………
……………………………………………………
……………………………………………………
(Insert resolution Nos, brief description or nominees’ name/s)