PROXY TO VOTE IN STOCKHOLDERS’ MEETING

KNOW ALL MEN BY THESE PRESENTS:

That I, _____________, Filipino, of legal age, (single/married/widow), and a resident of

_____________, Philippines, do hereby constitute and appoint _Name of Proxy_, who is also of
legal age, Filipino, (single/married/widow), and a resident of _____________, Philippines, to
represent me and vote the ______________________ (___________) shares of the capital stock
appearing in my name at the Annual Stockholders’ Meeting of _Name of Corporation_, to be
held on _____________.

IN WITNESS WHEREOF, I have hereunto set my hand this________, day of_____,

2___, at the City of ______________, Philippines.

STOCKHOLDER

Accepted by:

PROXY

SIGNED IN THE PRESENCE OF:

______________________ ______________________

ACKNOWLEDGEMENT