________ (ACN ________)
(hereinafter "the Company")
APPOINTMENT OF PROXY
(Pursuant to section 249X of the Corporations Act 2001 (Cth))
§1. APPOINTING MEMBER
1.1 I/We, ________ of ________ (Member identification/Holder number: ________), being a member of the Company entitled to attend and vote at the meeting referred to in this instrument, hereby appoint the proxy named in §2 below.
§2. APPOINTMENT OF PROXY
2.1 I/We appoint ________ of ________ or, failing the person so named, the Chairperson of the meeting, as my/our proxy to attend, speak and vote for me/us and on my/our behalf.
2.2 Where the person named in §2.1 is not appointed or is unable or unwilling to act, the Chairperson of the meeting is taken to be appointed as my/our proxy in accordance with section 250BB of the Corporations Act 2001 (Cth).
§3. THE MEETING
3.1 This appointment relates to the ________ general meeting of the Company to be held on ________ at ________ at ________, and to any adjournment or postponement of that meeting.
§4. VOTING INSTRUCTIONS
4.1 I/We direct my/our proxy to vote on the resolutions to be considered at the meeting as follows:
Resolution: ________ — (For / Against / Abstain): ________
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§5. POWERS AND OPERATION OF PROXY
5.1 This appointment of proxy is valid for the meeting specified in §3 and any adjournment or postponement of that meeting only.
5.2 If two proxies are appointed, each proxy may exercise one half of the votes unless the proportion or number of votes each proxy may exercise is specified here: ________. Neither proxy may vote on a show of hands where two proxies are appointed.
5.3 The appointment of a proxy does not preclude me/us from attending and voting in person at the meeting, in which case this appointment is suspended while I/we are present.
5.4 I/We may revoke this appointment at any time before the relevant vote by notice in writing delivered to the Company at its registered office, or by attending and voting in person.
§6. LODGEMENT
6.1 To be effective, this instrument (and, where the appointing member is a body corporate or where the instrument is signed by an attorney, the authority under which it is signed or a certified copy of that authority) must be received by the Company at ________ not later than 48 hours before the time for holding the meeting, in accordance with section 250B of the Corporations Act 2001 (Cth).
§7. EXECUTION
Signed by the appointing member ________:
Signature: ......................................................
Date of signing: ________
Where the appointing member is an individual:
Witness signature: ......................................................
Witness name: ________
Witness address: ________
Where the appointing member is a body corporate, executed in accordance with section 127 of the Corporations Act 2001 (Cth):
Director signature: ......................................................
Name of Director: ________
Director/Company Secretary signature: ......................................................
Name of Director/Company Secretary: ________