(Subsection 102(2) and paragraphs 51(1)(e) and 66.15(3)(b) of the Act)
(Title Form 1)
I, (name of creditor), of (name of town or city), a creditor in the above matter, hereby appoint , of , to be my proxy holder in the above matter, except as to the receipt of dividends, with (or without) power to appoint another proxy holder in his or her place.
Dated at , this day of .
Name of Corporate Creditor
Name and Title of Signing Officer
Note: If a copy of this Form is sent electronically by means such as email, the name and contact information of the sender, prescribed in Form 1.1, must be added at the end of the document.
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