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Appointment of Proxy - Template, Sample Form

________ (ACN................................................)

(hereinafter "the Company")


APPOINTMENT OF PROXY


I, ________ of ________, being a member of the Company, hereby appoint ________ of ________, a member of the Company as my proxy to vote for me on my behalf at the meeting of the Company, to be held on ________, and at any adjournment thereof. In the event that no specific voting instructions are provided herein, my proxy

________ is authorised to vote on my behalf at their discretion in relation to any matters handled at the meeting.


Signed by ________:.......................................................

Fields you complete are inserted into the document live. This template is general guidance only - not legal advice.