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Irrevocable Proxy



IRREVOCABLE PROXY

For payment of one dollar ($1) and other compensation, I hereby confer upon a proxy to vote [Number of shares] shares of [Name of Corporation], hereinafter "Corporation", in my stead and on my behalf at the Corporation shareholders' meeting to be held on [Date of meeting]. The proxy is conferred in consideration of the following conditions:

FIRST Said person shall have all the power to vote and attend the aforesaid meeting as I currently enjoy.

SECOND This proxy, which may not be revoked by myself, nor my heirs or assigns, shall not last for a period beyond the above noted shareholders' meeting, or any extension thereof.


Signed Date