FORM OF PROXY - SAMPLE FORM OF PROXY

Oleh Unknown

Thursday, March 8, 2012

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XXXXXX XXXXXXXXX XXXX (PVT) LTD

FORM OF PROXY

I/We ………………………………………………………………………….

Of …………………………………………………………………………….

Being a Share holder of the Xxxxxxx Xxxxxx (Pvt) Ltd hereby appoint:

* Kapila Basnayaka                                       Of Colombo or failing him.

* Lilananda Gamachci                                  Of Colombo or failing him.

* Dewaka Kure                                             Of Colombo or failing him.

…………………………………………………………………………………………… as my/our Proxy to represent me/us and on my/our behalf at the Extraordinary General Meeting of this Corporation to be held on 17^th December 2012. at 5.00 p.m. at any adjournment thereof, and at every poll which may be taken in consequence thereof.

As witness my/our hand this 17^th day of December 2012.

                                                                                    …………………..

Signature.

NOTICE:

01.  Please delete inappropriate words as applicable.

02.  Instructions as to the completion of this form are given overleaf.

03.  A Proxy need not be a member of the Corporation.