(Name of the Corporation)

Address

PROXY FORM

To the Corporate Secretary:

I, _____________________________, a shareholder of ____________________________

(the “Corporation”) owning ___________________________ (_____________) shares,
hereby state that I will be absent during the Special Shareholders Meeting to
be held on _________________________. As such, I hereby constitute and name
_________________________ to be my true and lawful Proxy for me and in my name,
place and stead to vote as my Proxy at the aforesaid meeting which shall
include, but not limited to, the casting of my vote for the Election of Directors,
as well as the transaction of any business which may legally come before the
meeting and/or any adjournment thereof.

I hereby give my aforementioned Proxy to act for and in my behalf as

fully as I could do if personally present.

I hereby revoke any other Proxy heretofore given.

I hereby set my hand this _____ of April 2017 at the City of ____________,
Philippines.

_______________________________

(Name, Signature)