Proxy Voter Form for; Whangawehi 1B5B2B Ahu Whenua Trust
Todays Date............................
I ................................................................................................................(name shown on List of Owners)
of ..............................................................................................................(Address)
................................................................(Town).................................................................(Country)
................................................................(Phone)................................................................(Email)
being a beneficial owner of the land, appoint; ....................................................................
(Proxy Holder) to be my Proxy holder at the meeting of owners that will take place on the
(Date) ............................ at .............................................................
I direct my Proxy holder to;
1) Vote as the Proxy Holder decides
2) Vote for / against, any resolutions and/or Directions specified by the Chief Judge................. MLC
proposed for determination at this meeting.
Name of Owner:..........................................................................
Signature of Owner:.....................................................................
JP's Medical Practitioner, Pharmaceutical, Head Master, Post Master
Signed in the presence of: [signature of witness]............................................................................
Full name of witness (block letters): ..............................................................................................
Occupation:....................................................................................................................................
Address:.........................................................................................................................................
Phone Email;