Form No. 037 - Form of proxy - Company Court Rules, 1959

Form No. 37 (See rule 73) [Heading as in Form No. 1] Company Application No. ................... of 19 .......... ................... Applicant(s) Form of proxy I, the undersigned [an unsecured creditor], of the above company hereby appoint C.D., of etc., and failing him X.Y., of etc, as my proxy, to act for me at the meeting of [unsecured creditors] to be held at ........... on the ............ day of .............. 19 ........, at .................. o'clock in the .................. noon, for the purpose of considering and, if thought fit, approving, with or without modification, a compromise or arrangement proposed to be made between the said company and its unsecured creditors] and at such meeting and any adjournment thereof, to vote for me, and in my name .................. [here, if 'for', insert 'for'; if 'against', insert 'against', and in the latter case, strike out the words below after 'compromise or arrangement'] the said compromise or arrangement either with or without modification as my proxy may approve. [strike out what is not necessary] Dated this .................. day of .................. 19 ......... Signature .................. Address ..................