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NEBRASKA IMMUNIZATION ADMINSTRATION PROXY FORM I have been given a copy and have read or have had explained to me the information in the Vaccine Information Statement(s) for the vaccine(s) checked

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How to fill out this proxy form is

01

Obtain the proxy form from the organization or company.

02

Fill out your personal information, including your name and contact details.

03

Identify the person or entity you are authorizing to act as your proxy.

04

Sign and date the form to make it legally binding.

05

Submit the completed form to the organization or company according to their instructions.

Who needs this proxy form is?

01

Anyone who is unable to attend a meeting or vote in person but still wants their voice to be heard and their vote counted.

02

Individuals who are assigning someone else to make decisions on their behalf due to physical or geographical constraints.

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What is this proxy form?

A proxy form is a document that allows an individual to authorize another person to act on their behalf in voting or decision-making processes, typically related to corporate governance or shareholder meetings.

Who is required to file this proxy form?

Shareholders of a corporation who wish to assign their voting rights to another individual or entity are required to file a proxy form.

How to fill out this proxy form?

To fill out a proxy form, individuals should provide their name, the name of the proxy they are appointing, details of the meeting, and any specific instructions regarding how the proxy should vote.

What is the purpose of this proxy form?

The purpose of a proxy form is to facilitate shareholder participation in meetings and enable individuals to vote even if they cannot attend in person.

What information must be reported on this proxy form?

The proxy form must report the shareholder's name, contact information, details of the proxy appointed, the meeting date, and any voting instructions or limitations.

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