PROXY

I, the undersigned member of the Insurance Brokers Association of Ontario, hereby

appoint Chris Floyd, President or failing him, Michael Brattman, President-Elect
or

instead

of

either

_______________________________________,

as my proxy to vote on behalf of myself as a member in good standing, at the General

Meeting of the Corporation to be held on October 22nd, 2014 and at all adjournments
thereof.
Dated the ____________ day of ___________________________ 2014.

Signature: _____________________________________________________________
Name of Member: _______________________________________________________
Name of Brokerage:______________________________________________________
RIBO Reg.# ____________________
Address: _______________________________________________________________
City / Town / Postal Code: _________________________________________________

IMPORTANT
All completed Proxies must be received at the
INSURANCE BROKERS ASSOCIATION OF ONTARIO OFFICE
1 Eglinton Avenue East, Suite 700, Toronto, Ontario M4P 3A1
by 10:00 a.m. on Friday, October 10th, 2014

via fax: (416) 488 7526

or email to proxy@ibao.on.ca
Please use this proxy form or an exact copy, as the information it provides
is necessary for accreditation purposes.