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the date below written and shall remain in full force and effect until______(5)______or unless specifically extended or rescinded earlier by either party.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），______（地址或律师事务所名称等），为我的律师，以我的身份履行一切实践中我通过律师所能从事的合法行为。本权利在以下载明日期全权生效并一直持续到______或持续到双方当事人规定的延展期或提前撤销期。
　　Dated______(6)______,______(7)______. ______(8)______
　　STATE OF______(9)______（签名处）
　　COUNTY OF______(10)______
　　日期：____________
　　地址：____________
　　州名和县名：______
　　PROXY委托书
　　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.
　　兹有我，______（姓名），为______（公司名称及性质）的以下署名股东，在此任命和指定______（姓名）为我的事实和合法授权代理人，为我和以我的名义、职位和身份，在上述公司于______（日期）召开的或就此延期召开的股东大会上作为我的代理人对与会前合法提交大会讨论的任何事项进行表决，且为我和以我的名义，在大会上全权履行我的职责；在此我撤销此前所作的任何其他授权委托。
WITNESS my hand and seal this______(6)______day of______(7)______,______(8)______.
于______年______月______日签字盖章，特此为证。