Whistleblowers Australia
Proxy Form
Appendix 2 to The Constitution
To: The Secretary
Whistleblowers Australia Inc.
7A Campbell Street
Balmain NSW 2041
Proxy Vote
I [name]______________________________________________________
of [address]____________________________________________________
______________________________________________________________,
a member of Whistleblowers Australia, hereby appoint
[name] _______________________________________________________
of [address]____________________________________________________
______________________________________________________________
to vote for me and on my behalf at the AGM of the organisation to be
held on
[date]_________________________ at [venue and address]
___________________________________
___________________________________________________________ and at
every adjournment thereof.
As witness my hand [signature]_________________________________________
this ____________________ day of __________________ 20___.