Proxy Revocable

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}}

Website: {{website}}

Notice of Revocation of Proxy

Date: {{date}}

To: The Board of Directors of {{company_name}}

And to: {{proxy_holder_name}} (the "Proxy Holder")

Shareholder Information

I, {{shareholder_name}}, residing at {{shareholder_address}}, and being a duly registered shareholder of {{company_name}}, holding {{number_of_shares}} ordinary shares in the company (the "Shares"), hereby provide this formal notice.

Revocation of Previous Proxy

Pursuant to the powers vested in me as a shareholder, I hereby irrevocably revoke any and all proxy appointments previously granted by me to the Proxy Holder, including, but not limited to, the proxy dated {{original_proxy_date}} (the "Original Proxy"), which authorized the Proxy Holder to vote on my behalf at the {{meeting_type}} meeting of shareholders held on {{meeting_date}}, or any adjournment thereof.

This revocation is effective immediately upon the date first written above.

Restoration of Voting Rights

By this instrument, I reaffirm my sole and exclusive right to vote the Shares and to exercise all other shareholder rights associated with the Shares, effective immediately. The Proxy Holder is hereby notified that they no longer have any authority whatsoever to act or vote on my behalf with respect to the Shares.

Instructions to Company Secretary

I instruct the Company Secretary of {{company_name}} to record this revocation in the company's register of shareholders and to ensure that any future voting forms or communications relating to the Shares are directed solely to me, the undersigned shareholder.

Acknowledgment of Receipt

A copy of this Notice of Revocation of Proxy should be delivered to the Proxy Holder named above, and the Company Secretary is requested to acknowledge receipt of this revocation by countersigning in the space provided below.

Signature Block

_____________________________

{{shareholder_name}}

Shareholder

Date: {{date}}

Acknowledged and Received by:

_____________________________

Company Secretary, {{company_name}}

Date: {{date}}