Whistleblowers Australia
Proxy Form
Appendix 2 to The Constitution

To: The Secretary
Whistleblowers Australia Inc.
7A Campbell Street
Balmain NSW 2041

Proxy Vote

I [name]______________________________________________________
of [address]____________________________________________________
______________________________________________________________,

a member of Whistleblowers Australia, hereby appoint

[name] _______________________________________________________
of [address]____________________________________________________
______________________________________________________________

to vote for me and on my behalf at the AGM of the organisation to be held on
[date]_________________________ at [venue and address] ___________________________________
___________________________________________________________ and at every adjournment thereof.

As witness my hand [signature]_________________________________________

this ____________________ day of __________________ 20___.



Constitution