PROXY FORM

KNOW ALL MEN BY THESE PRESENTS:

That I, the undersigned, a stockholder of VISAYAS AVENUE MEDICAL CENTER, INC., a

Philippine Corporation, do hereby nominate, constitute and appoint
Samantha Katrina S. Reyes
______________________________________ as my proxy to represent me, and vote all shares registered
in my name in the books of the Corporation, or owned by me at VAMC 1st Annual Stockholders’
I

Meeting thereof, to be held on July 18, 2021 and any adjournment thereof, as fully to all intents and
purposes as I might do if present and acting in person, hereby confirming and ratifying all acts which
my above named proxy may lawfully do or cause to be done in the premises.

Bulacan
IN WITNESS WHEREOF, I have signed these presents at __________________, Philippines this
17th July
________ day of ___________________, 2021.
earn
Name and Signature of Appointing Stockholder: Ma. Patricia R. Riego de Dios
____________________________________________________________
58 Vicente Avenue, North Susana Executive Village, Matandang Balara,
Quezon City
Address: ____________________________________________________________
____________________________________________________________

A ar
Signed in the presence of:

Jose Joaquin R. Riego de Dios Maria Lilia R. Riego de Dios

_________________________ __________________________

5 Malumanay Street Barangay UP Village, Quezon City

Email: visayasavenuemedicalcenterqc@gmail.com