Our Organisation

Diabetes WA

Proxy Form – 2021 Annual General Meeting

Proxy Form Instructions

Download the Proxy Form to print, complete and lodge with Diabetes WA Company Secretary at least 48-hours prior to the start of the meeting.

Download the Proxy Form


Appointment of proxy

Indicate who you wish to appoint as your proxy. A proxy need not be a member of Diabetes WA.
If you wish to appoint the Chairperson, mark the box. If you wish to appoint another person as your proxy, write their full name. If you don’t write the name of a proxy, or your named proxy does not attend the meeting, the Chairperson will be your proxy.
If a person attends a meeting both as a member and as a proxy for another member, that person will only be counted once on a show of hands.

Voting directions

Mark one of the boxes opposite each item of business to direct your proxy how to vote. If no directions are given, the proxy may vote as the proxy thinks fit or may abstain from voting. If you mark more than one box on an item your vote on that item will not be valid.

Signing instructions

To be valid this form must be signed by the member. If signed by the member’s attorney, the power of
attorney must have been previously provided to Diabetes WA or a certified copy attached to this form. If executed by a company, the form must be executed in accordance with the shareholder’s constitution and the Corporations Act 2001 (Cth).

Lodgement of proxy form

This proxy form must be received by Diabetes WA at least 48 hours prior to the start of the meeting, or by 5.30pm (WST) on Tuesday 26 October 2021.

Proxy forms (and any power of attorney under which they are signed) may be lodged:

By email [email protected]
By mail Attention: Company Secretary
Diabetes WA Ltd
PO Box 1699
Subiaco WA 6904

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