AGM Proxy Appointment Form
Appoint a proxy to attend and vote at the Annual General Meeting on your behalf. Please complete all required fields accurately.
Shareholder Full Name
*
First Name
Last Name
Shareholder Email Address
*
example@example.com
Shareholder Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Proxy Full Name
*
First Name
Last Name
Proxy Email Address
example@example.com
Proxy Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship of Proxy to Shareholder
*
Please Select
Family Member
Friend
Legal Representative
Company Officer
Other
Date of Annual General Meeting
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Voting Instructions for Proxy
*
Proxy may vote as they see fit
Proxy must vote in accordance with attached instructions
Additional Instructions (if any)
Appoint Proxy
Should be Empty: