New South Wales Consolidated Regulations

RETIREMENT VILLAGES REGULATION 2000 - SCHEDULE 9

SCHEDULE 9 – Form of appointment of proxy

(Clause 37 (1))

Retirement Villages Act 1999

I,

(a) any matter in respect of which the consent of residents is required under the Retirement Villages Act 1999 , and

(b) any other matter affecting the management and operation of the village.

I authorise my proxy to vote on my behalf in respect of (tick whichever applicable):

□ all matters raised at the meeting at their discretion, or

□ the following matters only:

[Specify the matters and any limitation on the manner in which you want your proxy to vote]

Signature of resident

Signed thisday of, 20

Note:

1 A person who may be appointed as a proxy includes a spouse, another resident, a relative, friend or other person, but no person may hold more than 5 proxies at the same time.

2 The Act does not allow an operator, or a close associate of the operator (including an agent or employee) or a person nominated by the operator to hold or exercise a proxy on behalf of a resident, unless the resident is a relative of the operator.

3 This appointment is effective only if this duly-completed form is given, before any vote is taken, to the chairperson of the meeting at which the proxy is to vote.

4 However, this form does not authorise voting on a matter if the person appointing the proxy is present at the relevant meeting and personally votes on the matter.

5 This appointment terminates after the first meeting at which it is exercised or 6 months from the date the appointment is made, whichever occurs first.

6 This form may be revoked at any time by the resident giving notice in writing to the person appointed as the resident’s proxy.