i,______(1)______,of______(2)______,hereby appoint______(3)______,of______(4)______,as my attorney in fact to act in my capacity to do every act that i may legally do through an attorney in fact. this power shall be in full force and effect on the date below written and shall remain in full force and effect until______(5)______or unless specifically extended or rescinded earlier by either party.
我，______（姓名），______（地址等），在此指定______（姓名），______（地址或律師事務所名稱等），為我的律師，以我的身份履行一切實踐中我通過律師所能從事的合法行為。本權利在以下載明日期全權生效並一直持續到______或持續到雙方當事人規定的延展期或提前撤銷期。
dated______(6)______,______(7)______. ______(8)______
state of______(9)______（簽名處）
county of______(10)______
日期：____________
地址：____________
州名和縣名：______
proxy委託書
be it dnown, that i,______(1)______,the undersigned shareholder of______(2)______,a______(3)______corporation, hereby constitute and appoint______(4______as my true and lawful attorney and agent for me and in my name, place and stead, to vote as my proxy at the meeting of the shareholders of the said corporation, to be held on______(5)______or any adjournment thereof, for the transaction of any business which may legally come before the meeting, and for me and in my name, to act as fully as i could do if personally present; and i herewith revoke any other proxy heretofore given.
茲有我，______（姓名），為______（公司名稱及性質）的以下署名股東，在此任命和指定______（姓名）為我的事實和合法授權代理人，為我和以我的名義、職位和身份，在上述公司於______（日期）召開的或就此延期召開的股東大會上作為我的代理人對與會前合法提交大會討論的任何事項進行表決，且為我和以我的名義，在大會上全權履行我的職責；在此我撤銷此前所作的任何其他授權委託。
witness my hand and seal this______(6)______day of______(7)______,______(8)______.
於______年______月______日簽字蓋章，特此為證。