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APNIC Proxy Form

I / We _____________________________________________________
                                  (person's name)
being a member of APNIC with  ________________________ votes

HEREBY APPOINT
____________________________________________________________
                                  (person's name)
of
____________________________________________________________
                                  (company name)
or failing him/her
____________________________________________________________
                                  (person's name)
of
____________________________________________________________
                                 (company name)
to be my/our proxy to vote for me/us at the meeting of members 

to be held on the _________ day of ___________ 20______ and

at any adjourment thereof.
___________________________________________________________
(Any restrictions on voting to be inserted here)

Signed this ___________ day of __________________ 20_______
                  (day)             (month)            (yr)

___________________________________________________________
                                            (member's name)

___________________________________________________________
                                       (member's signature)

___________________________________________________________
                            (member's contact phone number)

___________________________________________________________
                        (member's contact facsimile number)

___________________________________________________________
                           (member's contact email address)