Schedule 3 Form of appointment of proxy

Schedule 3 Form of appointment of proxy

section 23(1)

Retirement Villages Act 1999

I, [insert name of resident], being a resident of [insert address of resident], appoint [insert name of proxy holder] of [insert address of proxy holder] as my proxy to vote for me at a meeting of residents held for the purpose of considering and voting on—

(a) matters for which the consent of residents is required under the Retirement Villages Act 1999, and

(b) matters affecting the management and operation of the village.

I authorise my proxy to vote on my behalf in relation to [tick whichever is applicable]—

□ all matters raised at the meeting at my proxy’s 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—

Date of signature—

Notes—