Proxy Application Form

Please complete the details below to authorise a trusted representative to vote on your behalf.

Your Details

Enter your details in the fields below

First Name *

Last Name *

Email Address *

ID Number *

Your Address

Erf No. *

Street Name and Number *

City / Town *

Suburb *

Postal Code *

Proxy Details

Enter your selected proxy's details below

Proxy First Name *

Proxy Last Name *

Proxy ID Number *

Your Signature *

I, ______________________, ID number ______________________ of the following address: ______________________ erf number: ______________________ hereby appoint ______________________, ID number ______________________ as my proxy to sign the Consent/Object Form either in paper form or online for the proposed establishment of Graaff-Reinet Community Improvement District (GRT CID) and is authorized to represent me on my behalf at their discretion in relation to any matters related to the Graaff-Reinet Community Improvement District.

Confirmation

Signed Date

Date: 05/08/26

Proxy Application Form

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