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CARTA PODER (Original) PROXI (Original)

----------. -------- de---------de 19----- (There follow three blanks), one thousand
Señores:----------del nine hundred and (there follows a blank).................................
Colegio de -------- To the (there follows a blank) of the
Dr-------- Association of (there follows a blank),
S/D (there follows a blank), His Office............................................
De mi consideración: Be it known, that the undersigned,
El que suscribe,------- inscripto en la registered in Volume (there follows a
Matrícula Profesional al tomo ----- folio blank) on folio (there follows a blank) of
--------, se dirige al Sr. ------ a fin de the Professional Registry, hereby states that
hacerle saber que ha designado al he constitutes and appoints (there follows a
matriculado --------, inscripto en la blank), registered in Volume (there follows
Matrícula Profesional al tomo -------- folio a blank) on Folio (there follows a blank) of
------, quien también firma la presente, para the Professional Registry, who signs this
que lo represente en la Asamblea General Proxy as well, his Agent to act at the
Ordinaria de fecha ---------- convocada por General Meeting called by said
ese Colegio. El mandato se otorga para el Association, to be held on (there follows a
tratamiento y la votación de los puntos blank), in order to deal with the (there
------- del Orden del Día. El suscripto está follows a blank) matters of the Agenda (1)
al día en el pago de la cuota anual. and vote them thereat. The undersigned
Saluda a Ud. muy atentamente. acknowledges no indebtedness whatsoever
Firma concerning yearly payment of said
Aclaración de firma Mandante Association. Yours truly...........................................................
Firma There follow four blanks and the following
Aclaración de firma Mandatario expressions before each of them:
“Signature”; “Print Donor’ s name”;
“Signature”; “Print Agent’ s name”..........................................
Nota: Esta carta poder es válida para Note: This proxy is valid to vote all the
intervenir en todas las resoluciones, con resolutions, except those referring to
excepción de aquellas relacionadas con la election of officers according to Section
elección de autoridades, según lo (there follows a blank) of the Rules, where
establecido en el artículo ------ del the (there follows a blank) Title, Elections,
Reglamento, Título -------. De las states as follows: “Votes shall be personal
elecciones: “El voto será personal y and by ballot”............................................................................
secreto”.
La firma del mandatario debe ser Agent’ s signature shall be certified by a
certificada por Escribano Público, Policía Notary Public, the Federal Police or any
Federal o Banco y, hasta 48 hs. Antes (es Bank, and free at the aforementioned
decir, hasta el ------), gratuitamente en el Association up to forty-eight hours before
Colegio. the Meeting (that is, up to (there follows a
blank)........................................................................................
...................................................................................................
Alternative words and expressions: (1)
Order of Business......................................................................

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