Ballot
[Nature of Meeting (ie. Annual, General, Special, etc.)] Meeting of the Shareholders of [Name of
Corporation] (the "Corporation") held on [Date of Meeting (ie. August 31, 2002)].
Ballot on [Nature of Resolution (ie. Special)] Resolution re [Purpose of Resolution (ie. Election of
Directors)]
The undersigned hereby votes and records all votes in respect of all voting shares held by the
undersigned in the Corporation (and all votes in respect of all shares in the said Corporation held by each
shareholder of the said Corporation for whom the undersigned has been appointed proxy) in the manner
indicated below:
1. SHARES HELD BY PROXIES
FOR the Resolution:
(number of votes)
AGAINST the Resolution:
(number of votes)
2. SHARES HELD BY THE UNDERSIGNED
FOR: or AGAINST: the Resolution
[Check only one] (number of votes)
x
Please print full name Signature
[To be filled in by Scrutineers]
Number of Shares held:
Number of Shares represented by proxy:
TOTAL