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FORM OF PROXY - SAMPLE FORM OF PROXY



XXXXXX XXXXXXXXX XXXX (PVT) LTD



FORM OF PROXY

I/We ………………………………………………………………………….

Of …………………………………………………………………………….

Being a Share holder of the Xxxxxxx Xxxxxx (Pvt) Ltd hereby appoint:

* Kapila Basnayaka                                       Of Colombo or failing him.
* Lilananda Gamachci                                  Of Colombo or failing him.
* Dewaka Kure                                             Of Colombo or failing him.



…………………………………………………………………………………………… as my/our Proxy to represent me/us and on my/our behalf at the Extraordinary General Meeting of this Corporation to be held on 17th December 2012. at 5.00 p.m. at any adjournment thereof, and at every poll which may be taken in consequence thereof.

As witness my/our hand this 17th day of December 2012.


                                                                                    …………………..
Signature.

NOTICE:

01.  Please delete inappropriate words as applicable.

02.  Instructions as to the completion of this form are given overleaf.

03.  A Proxy need not be a member of the Corporation.

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