Proxy Form

This form must be HANDWRITTEN BY THE VOTING MEMBER ASSIGNING the Proxy

General Meeting (dd/mm/yy)                                               

I hereby authorise (name of member)                                                                                              
to serve as my proxy and to vote on my behalf at the
(month)                                                                                                  General Meeting.

 

This proxy is valid for:(please select one with a tick)
[    ]  All matters
[    ]  Specific issues/matters. Please explain the issues/matters below - e.g. specific motion(s).

 

 

 

 

A voting member wishing to vote at the meeting via proxy shall designate a voting member of the Society. A voting member wishing to vote by proxy shall personally contact the member for whom they wish to exercise their proxy and must complete this form by hand (not typed). The appropriately completed form may be mailed, emailed as a scanned document or faxed, or hand delivered by the proxy holder to the Secretary prior to the meeting.

Name:                                                                                                                                             

Signature:                                                                                                                                     

Date: