Form of Proxy

To: the Managers of China Shipowners Mutual Assurance Association

The undersigned hereby appoints …………… to be the proxy to attend and vote on behalf of the undersigned at the General Meeting of Members to be held on ………………………….

Unless otherwise instructed, the proxy will exercise the functions and powers of a
Member as he thinks fit.

As witness the hand of the undersigned this day

of …………………………………………

by …………………………………  (the stamp of the company)