Iranian Canadian Congress

Proxy Form

The Undersigned,

(Name)………………………………………………………………………

hereby appoint:

Mr/Mrs………….…..………………………………………………………

as my proxy to attend the GM and vote on my behalf at the meeting to be held on

28^th of June 2009, in respect of the items on the agenda.

Dated at (City) ____________ this day of (date) _____________

(signed) ___________