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Revocable Proxy

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If you cannot attend a shareholders’ meeting, use this Revocable Proxy to appoint another individual to vote on your behalf. This proxy is revocable and allows the shareholder to revoke or terminate the proxy at anytime. Customize the name of the corporation, the name of the proxy, the number of shares, the date of the meeting, and more. This agreement can be used by individuals or small businesses that own shares in a corporation and want to allow another individual to vote on their behalf at shareholders’ meetings.

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									Revocable Proxy
If you cannot attend a shareholders’ meeting, use this Revocable Proxy to appoint
another individual to vote on your behalf. This proxy is revocable and allows the
shareholder to revoke or terminate the proxy at anytime. Customize the name of the
corporation, the name of the proxy, the number of shares, the date of the meeting, and
more. This agreement can be used by individuals or small businesses that own shares
in a corporation and want to allow another individual to vote on their behalf at
shareholders’ meetings.
                                          REVOCABLE PROXY

The undersigned, as a shareholder of ____________________, [Instructions: Insert the name
of the Corporation] (the “Corporation”) hereby revokes any previous attorney-in-fact and/or
proxy and appoints ________________________ [Instructions: Insert the Proxy’s name] (the
“Proxy Holder”) as the undersigned’s attorney-in-fact and proxy, to attend all shareholders’
meetings, and to vote __________ (_____) [Instructions: Insert the number of shares that
Shareholder owns] shares of common stock of Corporation, represented by Certificate No.
__________ [Instructions: Insert the certificate number of the shares] and held of record in
the name of the undersigned (the “Shares”). The Proxy Holder shall have full power of
substitution and revocation and shall be empowered to execute consents and otherwise represent
the Shares in the same manner and with the same effect as if the undersigned were personally
present at such meeting or voting or personally acting on such matters submitted to shareholders
for approval or consent.

This appointment of attorney-in-fact and proxy is revocable at any time, and unless previously
revoked, shall terminate on ___________________. [Instructions: Insert the termination date]

Dated: _______________________ [Instructions: Insert the date]



________________________________ [Instructions: Insert Shareholder’s signature]
______________________ [Instructions: Insert the Shareholder’s name]
Shareholder




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