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PROXY FORM
ANNUAL GENERAL MEETING
(Please see notes overleaf before completing this Form)
LIPPO MALLS INDONESIA RETAIL TRUST
(Constituted in the Republic of Singapore pursuant to a
trust deed dated 8 August 2007)
IMPORTANT:
'PS JOWFTUPST XIP IBWF VTFE UIFJS $1' NPOJFT UP CVZ VOJUT JO -JQQP .BMMT *OEPOFTJB 3FUBJM 5SVTU
UIJT 3FQPSU JT GPSXBSEFE UP UIFN BU UIF SFRVFTU PG UIF $1' "QQSPWFE /PNJOFFT BOE JT TFOU
FOR INFORMATION ONLY.
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if used or purported to be used by them.
$1' JOWFTUPST XIP XJTI UP BUUFOE UIF .FFUJOH BT BO PCTFSWFS NVTU TVCNJU UIFJS SFRVFTUT UISPVHI
UIFJS $1' "QQSPWFE /PNJOFFT XJUIJO UIF UJNF GSBNF TQFDJöFE *G UIFZ BMTP XJTI UP WPUF
UIFZ NVTU
TVCNJU UIFJS WPUJOH JOTUSVDUJPOT UP UIF $1' "QQSPWFE /PNJOFFT XJUIJO UIF UJNF GSBNF TQFDJöFE UP
enable them to vote on their behalf.
I/We,
(Name)
of
(Address)
being a Unitholder/Unitholders of Lippo Malls Indonesia Retail Trust (“
LMIR Trust
”), hereby appoint:
Name
NRIC/Passport No.
Proportion of Unitholdings
No. of Units
%
Address
and/or (delete as appropriate)
Name
NRIC/Passport No.
Proportion of Unitholdings
No. of Units
%
Address
or failing the person, or either or both of the persons, referred to above, the Chairman of the Meeting as my/our proxy/proxies to
attend and vote for me/us on my/our behalf at the Fifth Annual General Meeting (the “Meeting”) of Unitholders of LMIR Trust to be
held at 333 Orchard Road, Singapore 238867, Mandarin Orchard Singapore, Mandarin Ballroom 3 on Monday, 28 April 2014 at
2:00 p.m. and at any adjournment thereof. I/We direct my/our proxy/proxies to vote for or against the Resolutions proposed at the
Meeting as indicated hereunder. If no specifc direction as to voting is given or in the event of any other matter arising at the Meeting
and at any adjournment thereof, the proxy/proxies will vote or abstain from voting at his/her discretion.
No.
Resolutions relating to:
No. of votes
‘For’*
No. of votes
‘Against’*
1 Report of the Trustee, Statement by the Manager, the Audited Financial
Statements of LMIR Trust for the fnancial year ended 31 December 2013 and the
Auditors’ Report thereon
2 3F BQQPJOUNFOU PG 34. $IJP -JN --1 BT "VEJUPST PG -.*3 5SVTU BOE UP BVUIPSJTF
UIF .BOBHFS UP öY UIF "VEJUPST SFNVOFSBUJPO
3 Authority to the Manager to issue new Units
* If you wish to exercise all your votes ‘For’ or ‘Against’, please tick (√) within the box provided. Alternatively, please indicate the number of votes as appropriate.
Dated this
day of
2014
Signature of Unitholder(s)/ Common Seal of Corporate Unitholder
Total number of Units in:
No. of Units
B
$%1 3FHJTUFS
(b) Register of Unitholders
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