Form of Proxy
“........................................ Mineral Exploration
Partnership, No Personal Liability”.
I, .............................. of .......................,
one of the shareholders of the above named partnership, being
the owner of ............................... shares of the said
partnership, hereby appoint M .................................
of ................................. as my proxy to vote for me
and in my name at a meeting of the shareholders to be held on
the .............................. day of ....................,
19....., at ...................................................
Dated at ................................., this ............
................ day of ............................, 19......
..................................
(Signature of constituent)
Signed in the presence of
...........................................
(Justice of the Peace or person
having the powers of a Justice of the Peace)
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R. S. 1964, c. 284, form 5.