You are on page 1of 1

NOTE: When the ballot is cast by a Shareholder, he or she signs on the first line.

If a proxy is
used to cast the ballot, the proxy signs the name of the Shareholder on the first line, then signs
his or her own name on the second line.

PROXY NOTICE FOR

__________________<Company Name>____________________

Annual Meeting of Shareholders

I, the undersigned Shareholder, hereby vote <Number> shares of stock for the following named
persons to serve as Directors for the ensuing term:

_________________________

_________________________

_________________________

_________________________

Date: ______________

_________________________
Shareholder

_________________________
Proxy

You might also like