Draft a sample proxy form with notes for members of PQR Promex Ltd. in relation to a general meeting in terms of provisions of Companies Act, 2013.

Form No. MGT-11 (Proxy Form) [Pursuant to section 105(6) of the Companies Act, 2013 and rule 19(3) of the Companies (Management and Administration) Rules, 2014] CIN: Name of the company: Registered office: Name of the member (s): Registered address: E-mail Id: Folio No/ Client Id: DP ID: I/We, being the member (s) of ............ shares of the above named company, hereby appoint 1. Name: ............ Address: ............ E-mail Id: ............ Signature:............, or failing him 2. Name: ............ Address: ............ E-mail Id: ............ Signature:............, or failing him 3. Name: ............ Address: ............ E-mail Id: ............ Signature:............, or failing him as my/our proxy to attend and vote (on a poll) for me/us and on my/our behalf at the ............ Annual general meeting/ Extraordinary general meeting of the company, to be held on the ............ day of....... At.......... a.m./p.m. at............ (place) and at any adjournment thereof in respect of such resolutions as are indicated below: Resolution No. 1. ............ 2. ............< 3. ............ Affix Revenue Stamp Signed this...... day of......... 20..... Signature of shareholder Signature of Proxy holder(s) Notes: This form of proxy in order to be effective should be duly completed and deposited at the Registered Office of the Company, not less than 48 hours before the commencement of the Meeting.