Proxy form

Structure Wellness Limited
FCA registration no. 9648
8 Stevenson Square, Manchester, M1 1FB

For the general meeting of Structure Wellness Limited to be held on

1. Member appointing a proxy

Member name

Member no. (if known)

Email or phone

2. Your proxy

I appoint the following person to attend, speak and vote on my behalf. A proxy doesn't need to be a member.

Proxy's full name

Or the chair of the meeting

3. Voting instructions

Your proxy must vote as you instruct (Rule 41). Write each resolution and tick one box.

Resolution	For	Against	Abstain	Proxy decides

4. Signature

Signature

Date

Deadline: this form must reach the Board at least 2 clear days before the meeting, or the appointment isn't valid (Rule 38). A proxy may act for no more than 3 members (Rule 39). The chair decides any question about whether a proxy is valid (Rule 40).

Office use only

Date received

Valid (yes/no)

Structure Wellness Limited · Community Benefit Society · FCA no. 9648