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(Proxy to Vote in Stockholders Meeting)
KNOW ALL MEN BY THESE PRESENTS:
That I, _____________, Filipino, of legal age, (single / married / widow), and a resident of _____________, Philippines, do hereby constitute and appoint __Name of Proxy__, who is also of legal age, Filipino, (single / married / widow), and a resident of _____________, Philippines, to represent me and vote the __________________________ (_________) shares of the capital stock appearing in my name at the Annual Stockholders Meeting of __Name of Corporation__, INC. to be held on _____________.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at the City of _____________, Philippines.
SIGNED IN THE PRESENCE OF: