EX-99.3 4 avino_ex993.htm FORM OF PROXY avino_ex993.htm
EXHIBIT 99.3
 
AVINO SILVER &
GOLD MINES LTD.
 
9th Floor, 100 University Avenue
Toronto, Ontario M5J 2Y1
www.computershare.com
     
    Security Class
     
    Holder Account Number
 
Form of Proxy - Annual General and Special Meeting to be held on June 22, 2012
 
This Form of Proxy is solicited by and on behalf of Management.
 
Notes to proxy
 
1.
Every holder has the right to appoint some other person or company of their choice, who need not be a holder, to attend and act on their behalf at the meeting or any adjournment or postponement thereof. If you wish to appoint a person or company other than the persons whose names are printed herein, please insert the name of your chosen proxyholder in the space provided (see reverse).
 
2.
If the securities are registered in the name of more than one owner (for example, joint ownership, trustees, executors, etc.), then all those registered should sign this proxy. If you are voting on behalf of a corporation or another individual you must sign this proxy with signing capacity stated, and you may be required to provide documentation evidencing your power to sign this proxy.
 
3.
This proxy should be signed in the exact manner as the name(s) appear(s) on the proxy.
 
4.
If this proxy is not dated, it will be deemed to bear the date on which it is mailed by Management to the holder.
 
5.
The securities represented by this proxy will be voted as directed by the holder, however, if such a direction is not made in respect of any matter, this proxy will be voted as recommended by Management.
 
6.
The securities represented by this proxy will be voted in favour or withheld from voting or voted against each of the matters described herein, as applicable, in accordance with the instructions of the holder, on any ballot that may be called for and, if the holder has specified a choice with respect to any matter to be acted on, the securities will be voted accordingly.
 
7.
This proxy confers discretionary authority in respect of amendments or variations to matters identified in the Notice of Meeting or other matters that may properly come before the meeting or any adjournment or postponement thereof.
 
8.
This proxy should be read in conjunction with the accompanying documentation provided by Management.
 
Proxies submitted must be received no later than forty eight (48) hours (excluding Saturdays, Sundays and holidays) prior to the time of the Meeting.
 
VOTE USING THE TELEPHONE OR INTERNET 24 HOURS A DAY 7 DAYS A WEEK!
 
 
Call the number listed BELOW from a touch tone telephone.   Go to the following web site: www.investorvote.com
  1-866-732-VOTE (8683) Toll Free      
 
If you vote by telephone or the Internet, DO NOT mail back this proxy.
 
Voting by mail may be the only method for securities held in the name of a corporation or securities being voted on behalf of another individual.
 
Voting by mail or by Internet are the only methods by which a holder may appoint a person as proxyholder other than the Management nominees named on the reverse of this proxy. Instead of mailing this proxy, you may choose one of the two voting methods outlined above to vote this proxy.
 
To vote by telephone or the Internet, you will need to provide your CONTROL NUMBER listed below.
 
CONTROL NUMBER
19AP12172.E.sedar/000001/000001/i
 
 
  1

 
 
+ +
 
Appointment of Proxyholder        
I/We, being holder(s) of Avino Silver & Gold Mines Ltd. hereby appoint:
David Wolfin, President and Director of the Company, or failing him, Dorothy Chin, Secretary of the Company,
OR Print the name of the person you are appointing if this person is someone other than the Chairman of the    
    Meeting.    
 
as my/our proxyholder with full power of substitution and to attend, act and to vote for and on behalf of the shareholder in accordance with the following direction (or if no directions have been given, as the proxyholder sees fit) and all other matters that may properly come before the Annual General and Special Meeting of shareholders of Avino Silver & Gold Mines Ltd. to be held at Suite 900, 570 Granville Street, Vancouver, British Columbia V6C 3P1, on June 22, 2012 at 11:00 a.m. Pacific Time, and at any adjournment or postponement thereof.
 
VOTING RECOMMENDATIONS ARE INDICATED BY HIGHLIGHTED TEXT OVER THE BOXES.
 
                      For   Against
                             
1. Number of Directors
                           
To set the number of Directors at 5.                        
                             
                             
                             
2. Election of Directors                            
  For   Withhold   For   Withhold   For   Withhold
                             
01. Michael Baybak
 
 
      02. Andrew Kaplan         03. Gary Robertson        
                             
04. David Wolfin
 
 
      05. Jasman Yee                  
                             
                      For   Withhold
                             
3. Appointment of Auditors
                           
Appointment of Manning Elliott as Auditors of the Corporation for the ensuing year and authorizing the Directors to fix their remuneration.    
                             
                      For   Against
                             
4. Rolling Stock Option Plan                            
To approve the Rolling Stock Option Plan as more particularly described in the Information Circular.    
                             
 
 
Authorized Signature(s) - This section must be completed for your instructions to be executed.   Signature(s)   Date
         
I/We authorize you to act in accordance with my/our instructions set out above. I/We hereby revoke any proxy previously given with respect to the Meeting. If no voting instructions are indicated above, this Proxy will be voted as recommended by Management.        DD/MM/YY
 

 
Interim Financial Statements - Mark this box if you would like to receive Interim Financial Statements and accompanying .     Annual Financial Statements - Mark this box if you would like to receive the Annual Financial Statements and    
Management's Discussion and Analysis by mail     accompanying Management's Discussion and Analysis by    
      mail.    
 
If you are not mailing back your proxy, you may register online to receive the above financial report(s) by mail at www.computershare.com/mailinglist.
 
  1 4 5 5 7 9 A R 1 B X V Q +
 
2