EX-99.5 6 d510203dex995.htm EX-99.5

Exhibit 99.5

1

VOTING INSTRUCTION FORM

1

P36028 E

1 OF 1

STANTEC INC.

12

MEETING TYPE:

ANNUAL MEETING

MEETING DATE:

THURSDAY, MAY 09, 2013 AT 10:30 A.M. MDT

RECORD DATE:

FOR HOLDERS AS OF MARCH 14, 2013

PROXY DEPOSIT DATE:

MAY 07, 2013

CUID:

ACCOUNT NO:

CUSIP: 85472N109

CONTROL NO.:

STEP 2 >

APPOINT A PROXY (OPTIONAL)

APPOINTEE(S): ARAM H. KEITH, ROBERT J. GOMES

IF YOU WISH TO ATTEND THE MEETING OR DESIGNATE ANOTHER PERSON TO ATTEND, VOTE AND ACT ON YOUR BEHALF AT THE MEETING, OR ANY ADJOURNMENT OR POSTPONEMENT THEREOF, OTHER THAN THE PERSON(S) SPECIFIED ABOVE, PRINT YOUR NAME OR THE NAME OF THE OTHER PERSON ATTENDING THE MEETING IN THE SPACE PROVIDED HEREIN. UNLESS YOU INSTRUCT OTHERWISE, THE PERSON WHOSE NAME IS WRITTEN IN THIS SPACE WILL HAVE FULL AUTHORITY TO ATTEND, VOTE AND OTHERWISE ACT IN RESPECT OF ALL MATTERS THAT MAY COME BEFORE THE MEETING OR ANY ADJOURNMENT OR POSTPONEMENT THEREOF, EVEN IF THESE MATTERS ARE NOT SET OUT IN THE FORM OR THE CIRCULAR.

PLEASE PRINT APPOINTEE NAME ABOVE

STEP 3 > COMPLETE YOUR VOTING DIRECTIONS

1 ELECTION OF DIRECTORS: VOTING RECOMMENDATION: FOR ALL THE NOMINEES PROPOSED AS DIRECTORS (FILL IN ONLY ONE BOX “ ” PER NOMINEE IN BLACK OR BLUE INK)

FOR

WITHHOLD

FOR

WITHHOLD

01-DOUGLAS K. AMMERMAN 07-ARAM H. KEITH

02-DAVID L EMERSON, PC

08-DONALD J. LOWRY

03-DELORES M. ETTER

09-IVOR M. RUSTE

04-ANTH0NY P. FRANCESCHINI

05-ROBERT J. GOMES

06-SUSAN E. HARTMAN

ITEM(S): (FILL IN ONLY ONE BOX “ ” PER ITEM IN BLACK OR BLUE INK)

VOTING RECOMMENDATIONS

2 *- THE REAPPOINTMENT OF ERNST & YOUNG, CHARTERED ACCOUNTANTS, AS ----->>>

FOR

WITHHOLD

2 <<<---

FOR

STANTEC’S AUDITOR AND AUTHORIZING THE DIRECTORS TO FIX THE AUDITOR’S REMUNERATION.

0010200

3 *- RESOLVED, ON AN ADVISORY BASIS AND NOT TO DIMINISH THE ROLE AND --->>>

FOR

AGAINST

3 <<<---

FOR

RESPONSIBILITIES OF THE BOARD OF DIRECTORS, THAT THE SHAREHOLDERS ACCEPT THE APPROACH TO EXECUTIVE COMPENSATION DISCLOSED IN STANTEC’S INFORMATION CIRCULAR DELIVERED IN ADVANCE OF THE MEETING.

0029440

*NOTE* THIS FORM CONFERS DISCRETIONARY AUTHORITY TO VOTE ON SUCH OTHER BUSINESS AS MAY PROPERLY COME BEFORE THE MEETING OR ANY ADJOURNMENT THEREOF.

*NOTE* THIS VOTING INSTRUCTION FORM SHOULD BE READ IN CONJUNCTION WITH THE ACCOMPANYING INFORMATION CIRCULAR.

STEP 4 > THIS DOCUMENT MUST BE SIGNED AND DATED

* ISSUER CONFIRMATION COPY - INFO ONLY *

SIGNATURE(S) *INVALID IF NOT SIGNED*

M M

D D

Y Y

VOTING INSTRUCTION FORM

STANTEC INC.

MEETING TYPE: ANNUAL MEETING

MEETING DATE: THURSDAY, MAY 09, 2013 AT 10:30 A.M. MDT

RECORD DATE: FOR HOLDERS AS OF MARCH 14, 2013

PROXY DEPOSIT DATE: MAY 07, 2013

A/C *** ISSUER COPY***

85472N109

STEP 1 > REVIEW YOUR VOTING OPTIONS

ONLINE: VOTE AT PROXYVOTE.COM

SCAN TO VIEW MATERIAL AND VOTE NOW

USING YOUR COMPUTER OR MOBILE DATA DEVICE.

BY TELEPHONE: YOU MAY ENTER YOUR VOTING INSTRUCTIONS BY TELEPHONE AT: 1-800-454-8683

BY MAIL: THIS VOTING INSTRUCTION FORM MAY BE RETURNED BY MAIL IN THE ENVELOPE PROVIDED.

REMINDER: PLEASE REVIEW THE INFORMATION / PROXY CIRCULAR BEFORE VOTING. SEE VOTING INSTRUCTION NO. 2 ON REVERSE

***WE NEED TO RECEIVE YOUR VOTING INSTRUCTIONS AT LEAST ONE BUSINESS DAY BEFORE THE PROXY DEPOSIT DATE.***

STEP 2 > COMPLETE YOUR VOTING DIRECTIONS

1 - ELECTION OF DIRECTORS: VOTING RECOMMENDATION: FOR ALL THE NOMINEES PROPOSED AS DIRECTORS (FILL IN ONLY ONE BOX “ ” PER NOMINEE IN BLACK OR BLUE INK)

FOR

WITHHOLD

01-D0UGLAS K. AMMERMAN

07-ARAM H. KEITH

02-DAVID L. EMERSON, PC

08-DONALD J. LOWRY

03-DELORES M. ETTER

09-IVOR M. RUSTE

04-ANTHONY P. FRANCESCHINI

05-ROBERT J. GOMES

06-SUSAN E. HARTMAN

FOR

WITHHOLD

ITEM(S): (FILL IN ONLY ONE BOX “ ” PER ITEM IN BLACK OR BLUE INK)

VOTING RECOMMENDATIONS

2 - THE REAPPOINTMENT OF ERNST & YOUNG, CHARTERED ACCOUNTANTS, AS STANTEC’S ----->>> AUDITOR AND AUTHORIZING THE DIRECTORS TO FIX THE AUDITOR’S REMUNERATION.

FOR WITHHOLD

3 - RESOLVED, ON AN ADVISORY BASIS AND NOT TO DIMINISH THE ROLE AND --->>> RESPONSIBILITIES OF THE BOARD OF DIRECTORS, THAT THE SHAREHOLDERS ACCEPT THE APPROACH TO EXECUTIVE COMPENSATION DISCLOSED IN STANTEC’S INFORMATION CIRCULAR DELIVERED IN ADVANCE OF THE MEETING.

FOR

AGAINST

2 <<<---

FOR

0010200

3 <<<---

FOR

0029440

*NOTE* THIS FORM CONFERS DISCRETIONARY AUTHORITY TO VOTE ON SUCH OTHER 8USINESS AS MAY PROPERLY COME BEFORE THE MEETING OR ANY ADJOURNMENT THEREOF.

*NOTE* THIS VOTING INSTRUCTION FORM SHOULD BE READ IN CONJUNCTION WITH THE ACCOMPANYING INFORMATION CIRCULAR.

FILL IN THE BOX “ ” TO THE RIGHT IF YOU PLAN TO ATTEND THE MEETING AND VOTE THESE SHARES IN PERSON.

STEP 3 > THIS DOCUMENT MUST BE SIGNED AND DATED

* ISSUER CONFIRMATION COPY - INFO ONLY *

SIGNATURE(S) *INVALID IF NOT SIGNED*

M M

D D

Y Y