Form of special proxy

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..... the...............day of..........20.........or at any adjournment thereof, to vote. [Here insert the word 'for' or the word 'against' as the case may require, and specify the particulars resolution] the resolution numbered .........in the notice convening the meeting. Dated this......day of.....20.... Signature: ............... Name : ...................... Notes: 1. It is open to a credito .....

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