EX-99.4 5 avino_ex994.htm VOTING INSTRUCTION FORM avino_ex994.htm
EXHIBIT 99.4
 
 
AVINO SILVER &
GOLD MINES LTD.
 
9th Floor, 100 University Avenue
Toronto, Ontario M5J 2Y1
www.computershare.com
     
    Security Class
     
    Holder Account Number
 
Voting Instruction Form ("VIF") - Annual General and Special Meeting to be held on June 22, 2012
 
NON-REGISTERED (BENEFICIAL) SHAREHOLDERS
 
1.
We are sending to you the enclosed proxy-related materials that relate to a meeting of the holders of the series or class of securities that are held on your behalf by the intermediary identified above. Unless you attend the meeting and vote in person, your securities can be voted only by Management, as proxyholder of the registered holder, in accordance with your instructions.
2.
We are prohibited from voting these securities on any of the matters to be acted upon at the meeting without your specific voting instructions. In order for these securities to be voted at the meeting, it will be necessary for us to have your specific voting instructions. Please complete and return the information requested in this VIF to provide your voting instructions to us promptly.
3.
If you wish to attend the meeting in person or appoint some other person or company, who need not be a shareholder, to attend and act on your behalf at the meeting or any adjournment or postponement thereof, please insert your name(s) or the name of your chosen appointee in the space provided (please see reverse).
4.
This VIF should be signed by you in the exact manner as your name appears on the VIF. If these voting instructions are given on behalf of a body corporate set out the full legal name of the body corporate, the name and position of the person giving voting instructions on behalf of the body corporate and the address for service of the body corporate.
5.
If this VIF is not dated, it will be deemed to bear the date on which it is mailed by Management to you.
6.
When properly signed and delivered, securities represented by this VIF will be voted as directed by you, however, if such a direction is not made in respect of any matter, the VIF will direct the voting of the securities to be made as recommended in the documentation provided by Management for the meeting.
7.
This VIF confers discretionary authority on the appointee to vote as the appointee sees fit in respect of amendments or variations to matters identified in the Notice of Meeting or other matters as may properly come before the meeting or any adjournment or postponement thereof.
8.
Should you wish to receive a legal form of proxy, please write to Computershare at the address indicated above and one will be sent to you by mail. Please remember that a legal proxy is subject to all terms and conditions that apply to proxies as outlined in the documentation provided by Management including any cut-off time for receipt.
9.
Your voting instructions will be recorded on receipt of the VIF and a legal form of proxy will be submitted on your behalf.
10.
By providing voting instructions as requested, you are acknowledging that you are the beneficial owner of, and are entitled to instruct us with respect to the voting of, these securities.
11.
If you have any questions regarding the enclosed documents, please contact the Registered Representative who services your account.
12.
This VIF should be read in conjunction with the accompanying documentation provided by Management.
 
 
VIFs submitted must be received no later than forty eight (48) hours (excluding Saturdays, Sundays and holidays) prior to the time of theMeeting.
 
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
  1-866-734-VOTE (8683) Toll Free      
 
If you vote by telephone or the Internet, DO NOT mail back this VIF.
 
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 choose an appointee other than the Management appointees named on the reverse of this VIF. Instead of mailing this VIF, you may choose one of the two voting methods outlined above to vote this VIF.
 
To vote by telephone or the Internet, you will need to provide your CONTROL NUMBER listed below.
 
CONTROL NUMBER
 
19AP12172.nobo.E.sedar/000001/000001/i
 
 
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Appointment of Proxyholder        
Management Appointees are: David Wolfin, President and Director of the Company, or failing him, Dorothy Chin, Secretary of the Company,
OR
If you wish to attend in person or appoint someone else to attend on your behalf, print your name or the name of your
   
    appointee in this space (see Note #3 on reverse).    
 
as my/our appointee to attend, act and to vote in accordance with the following direction (or if no directions have been given, as the appointee 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
         
If you are voting on behalf of a corporation or another individual you may be required to provide documentation evidencing your power to sign this VIF with signing capacity stated.
       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     Should you wish to receive a legal proxy, refer to Note #8 on reverse.
Management's Discussion and Analysis by mail     accompanying Management's Discussion and Analysis by      
      mail.      
 
If you are not mailing back your VIF, you may register online to receive the above financial report(s) by mail at www.computershare.com/mailinglist.
 
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