2021 Rockingham Kwinana Chamber of Commerce
ANNUAL GENERAL MEETING
4 November 2021
PROXY VOTE

Question Title

* 1. My details and contact Information

First Name

Last Name

Company

Email Address

Phone Number

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* 2. I confirm that I am UNABLE to attend the 2021 RKCC AGM and

I would like to allocate a current RKCC financial member as a proxy and I have confirmed that this person will be in attendance at the meeting

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* 3. PROXY VOTE - I hereby authorise current RKCC financial member named below to vote on all matters as a proxy on my behalf.

PROXY First Name

PROXY Last Name

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* 4. I understand ticking the box below is my form of electronic signature

Yes

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* 5. Submitted on

Date / Time

Date

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* 6. Office Use only - Signature of Proxy is required