AGM Proxy Form

SAMPLE PROXY FORM

I __________________________________________
am a financial member of InternetNZ.

I assign _____________________________________,
a financial member of InternetNZ,

to vote my proxy at the AGM/SGM (cross out one) of InternetNZ to be held on

________________________ (date).

My proxy is valid for the following issues: (cross out the two that do not apply)

All Elections only

Partial (detail here):

_____________________________________________________

My proxy is assigned FULL/PARTIAL/NO (cross out two)
discretion in the casting of my vote/s.

Signed:______________________________________ Member

Date: ______________________________________

NB All details must be filled in for this to be acceptable as an Instrument of Proxy
(Articles of Association 11.3)

All Proxies must be received at the Society's Office 48 hours before the scheduled start of the AGM/SGM either by Posting to:

InternetNZ
PO Box 11-881
Wellington

or by Fax to: +64 4-495-2115

you will need to send your Proxy Holder your online voting login and password as well. We suggest that you send this to them directly, but you can include it on this form if you wish and the Office will pass them on to them.

Online login: _________________________________

Online password: _________________________________

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AGM Proxy Form

SAMPLE PROXY FORM

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