Form of general proxy

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..... f .................. as my/our general proxy to vote for me/us and on my/our behalf at the meeting of creditors (or contributories) of the said company summoned to be held in the above matter on the ............. day of ................. 19 ........., and at any adjournment thereof. Dated this ................. day of ................. 19 ...... (Sd.) A.B. Notes. 1. It is open to a .....

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