Regd. Office: (Address)
THE _______ ANNUAL GENERAL MEETING OF THE COMPANY HELD AT
(ADDRESS) ON __DAY, 28TH SEPTEMBER, 2014 AT 10.30 A.M..
1. Name of the Member: Folio No.:
2. Voting power held (No. of Shares)
3. In case of a proxy, Name of the proxy:
Signature of the Voter