SURREY- AGM Proxy Form - NOTE please fill in one form per voter, each member council has up to 2 votes

You must fill out one form per voter

Question Title

* 1. Name of the Council?

Question Title

* 2. Name and details of the person formally appointed as proxy (the proxy can be a named individual or "the Chairman of the meeting") -

Name

Email *

Phone *

Question Title

* 3. Minute reference where proxy voter was formally appointed -

Question Title

* 4. The decisions are to be particularised e.g. leaving the voting decisions to the appointed proxy?

Yes

No