Corporate Proxy Template

[Corporation Name]
[Corporation Address]
[City, State, ZIP Code]

Date: [Date]

Subject: Corporate Proxy

1. Corporation Information

This Corporate Proxy is given with respect to:

Corporation Name: [Full Corporation Name]
State of Incorporation: [State]
Principal Office Address: [Address]

2. Shareholder Information

The undersigned shareholder is:

Shareholder Name: [Full Name]
Address: [Street Address]
City, State, ZIP Code: [City, State, ZIP Code]

Number of Shares Owned or Controlled: [Number of Shares]
Class or Series of Shares: [Common / Preferred / Other]

3. Appointment of Proxy Holder

I hereby appoint:

Proxy Holder Name: [Full Name]
Address: [Address]
City, State, ZIP Code: [City, State, ZIP Code]

as my true and lawful proxy and attorney-in-fact to appear, act, vote, and otherwise represent me with respect to the shares identified above.

4. Meeting or Corporate Action Covered

This proxy applies to the following meeting or action:

☐ Annual meeting of shareholders
☐ Special meeting of shareholders
☐ Adjournment or postponement of the meeting
☐ Written consent or other corporate action, if permitted
☐ Other: [Describe]

Meeting Date: [Date]
Meeting Time: [Time]
Meeting Location: [Location or “Virtual Meeting”]

5. Scope of Proxy Authority

This proxy is:

☐ General, giving the proxy holder authority to vote on all matters properly presented at the meeting
☐ Limited, giving the proxy holder authority only as specifically stated in this document

If this proxy is limited, the scope of authority is as follows:

[Describe the specific matters or limits]

6. Voting Instructions

The proxy holder shall vote the shares as follows:

A. Election of Directors

☐ Vote for all nominees proposed by management
☐ Vote according to the proxy holder’s judgment
☐ Vote as follows:

[Name of nominee / For / Against / Withhold]

B. Specific Proposal 1

Description of proposal:

[Describe proposal]

Vote instruction:

☐ For
☐ Against
☐ Abstain
☐ Discretion of proxy holder

C. Specific Proposal 2

Description of proposal:

[Describe proposal]

Vote instruction:

☐ For
☐ Against
☐ Abstain
☐ Discretion of proxy holder

D. Additional Matters

For any other matter properly presented at the meeting that is not specifically listed above, the proxy holder shall vote:

☐ In the proxy holder’s discretion
☐ As follows: [Describe]

7. Duration of Proxy

This proxy shall remain effective until:

☐ The conclusion of the meeting and any adjournment or postponement
☐ A specific expiration date: [Date]
☐ Revoked earlier by the shareholder
☐ Other: [Describe]

8. Revocation

I understand that this proxy may be revoked to the extent allowed by law, the corporation’s governing documents, and applicable meeting procedures.

Revocation may be made by:

• attending the meeting and voting in person, if permitted;

• delivering a later-dated proxy;

• delivering written notice of revocation; or

• any other valid method allowed under applicable law.

If this proxy is intended to be irrevocable, state the basis here:

[Describe or write “Not applicable”]

9. Reliance by Corporation

The corporation, its inspectors of election, officers, and agents may rely on this proxy unless they receive timely notice of revocation or a reason not to accept it under applicable law or corporate procedure.

10. Shareholder Certification

I certify that I am the shareholder of record, or otherwise authorized to grant this proxy for the shares identified above, and that I am signing this document voluntarily for the purpose stated herein.

11. Signature

Shareholder Signature: __________________________

Printed Name: [Shareholder Full Name]
Date: [Date]

12. Optional Witness or Corporate Acknowledgment

Witness or corporate representative, if applicable:

Signature: __________________________
Name: [Full Name]
Title: [Witness / Corporate Secretary / Other]
Date: [Date]

13. Optional Notary Acknowledgment

State of [State]
County of [County]

On this [Day] day of [Month], [Year], before me, the undersigned notary public, personally appeared [Shareholder Full Name], known to me or satisfactorily proven to be the person whose name is subscribed to this document, and acknowledged that they executed it for the purposes stated herein.

Notary Public Signature: __________________________
Printed Name: [Notary Name]
My Commission Expires: [Date]
Notary Seal: __________________________

14. Optional Internal Use Section

Received By: [Name]
Date Received: [Date]
Meeting Reference: [Reference Number or Notes]