EX-99.4 5 d353592dex994.htm EXHIBIT 99.4

Exhibit 99.4

Exhibit 99.4

VOTING INSTRUCTION FORM ONCOLYTICS BIOTECH INC. I I I I V C a 2 ‘- THE ELEC11ON OF DIRECTORS FROM THE MANAGEMENT PROPOSED NOMINEES. -->>> THE NOMINEES ARE: BRADLEY G. THOMPSON, MATTHEW C. COFFEY, WILIJAM A. COCHRANE, JIM DINNING, ED LEVY, J. MARK LIEVONEN, ROBERT B. SCHUL1Z, FRED A. STEWART AND GER VAN AMERSFOORT. 3 * TO APPOINT ERNST & YOUNG, LLP, CHARTERED ACCOUNTANTS, AS——->>> AUDITORS OF THE CORPORAflON AND AUTHORIZING THE DIRECtORS TO FiX THEIR REMUNERATION. 4 * TO APPROVE AND AUTHORIZE THE AMENDMENTS TO THE (RPORATIONS —>>> STOCK OPI1ON PLAN TO: INCREASE THE MAXIMUM NUMBER OF COMMON SHARES ISSUABLE PURSUANT TO THE EXERSE OF OP11ONS GRANTED THEREUNDER BY 1,883,060 COMMON SHARES TO 7,653,275 COMMON SHARES; TO INCORPORATE MINOR COMMENTS FROM THE TSX TO AIJGN THE STOQ( OPTION PLAN WITH TSX REQUIREMENTS AND TO CI.ARIFY THE AMENDING SECTIONS OF THE STOCK OFflON PLAN, All AS DESCRIBED IN THE INFORMATION CIRCULAR OF THE CORPORATION DATED MAY 14, 2012. *NOTE* THIS FORM XNFERS DISCRE11ONARY AIJ1HORETY TO VOTE ON SUCH OTHER BUSINESS AS MAY PROPERLY CX)ME BEFORE THE MEEI1NG OR ANY ADJOURNMENT THEREOF. *NOTE* THIS VOTING INSTRUCTION FORM SHOULD BE READ IN CONJUNCTION WItH THE ACCOMPANYING INFORMATION CIRCULAR. ONCOLYTICS BIOTECH INC. 210-1167 KENSINGTON CRESCENT N.W. CALGARY, AB T2N 1X7 CANADA * ISSUER CONFIRMATION COPY - INFO ONLY * ThiS FORM IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY PlEASE 00 NOT USE rr FOR VOTING PURPOSES. SIGNATURESJ DATE LDDEMWYY) IIVRI.II[.)i[I. ;1] APPO I NTE E S);0] SEE VOTING INSTRUCTIONS ON REVERSE INTERNET VOTE: WWWPROXYVOIE.COM WE NEED TO RECEIVE YOUR VOTING INSTRUCTIONS AT LEAST TELEPHONE VOTE: 1.SX-474J497 ONE BUSINESS DAY BEFORE THE PROXY DEPOSIT DATE. MEETING TYPE: ANNUAL AND SPECIAL MEE11NG MEETING DATE: WEDNESY, JUNE 20, 2012 AT 4:30 P.M. EDT RECORD DATE: FOR HOLDERS AS OF MAY 14, 2012 PROXY DEPOSIT DATE: JUNE 18, 2012 ACCOUNT NUMBER: CUSIP: 682310107 CUID: S92947 E CONTROL NO.: _________BRADLEY G. THOMPSON, DOUGLAS A. BALL IF YOU WiSH TO ATTEND THE MEE11NG OR DESIGNATE ANOTHER PERSON TO ATrEND, VOTE AND AC ON YOUR BEHALF AT THE MEEI1NG, OR ANY ADJOURNMENT THEREOF, OTHER THAN ThE PERSON(S) SPECIFiED ABOVE, PRINT YOUR NAME OR THE NAME OF THE PERSON ATTENDING THE MEETING ON THE APPOI WEE UNE BELOW. a PLEASE PRINT APPOINTEE NAME 1 * TO FIX THE NUMBER OF DIRECTORS TO BE ELECTED AT THE MEE11NG AT —>>> NINE (9). ;1] VOTING RECrr1ENDATIONS;0] FOR 0010110 THIS SPACE INTENTIONALLY LEFT BLANK. iii (FILL IN OILY ONE BOX - Ir PER ITEM IN SWE 01 BLACK INK) 2 ITEM(S) F AáIS1 SHARE(S) 1 D FOR D Tfl*IOLD D 0000 ;1] CONTROL NO 4;0] FOR 0010112 FOR 0010200 FOR 0022402 --->>> 2 —>>> 3 --->>> 4 Broad ridge’ 5970 CHED WORTH WAY MISGISSAUGA, ON LSR 404 C

4 1-0001 VOTING INSTRUCTION FORM ONCOLYTICS BIOTECH INC. I I liii SEE VOTING NO. INSTRUCTION ON REVERSE INTERNET VOTE: WWW.PROXYVOTE.COM TELEPHONE VOTE: 1-800-454-8683 MEETING TYPE: MEETING DATE: RECORD DATE: PROXY DEPOSIT DATE: ANNUAL AND SPECIAL MEEI1NG WEDNESDAY, JUNE 20, 2012 AT 04:30 P.M. EDT FOR HOLDERS AS OF MAY 14, 2012 JUNE 18, 2012 682310107 WE NEED TO RECEIVE YOUR VOTING INSTRUCTIONS AT LEAST ONE BUSINESS DAY BEFORE THE PROXY DEPOSIT DATE. 1 - TO FIX THE NUMBER OF DIRECTORS TO BE ELECTED AT ThE MEE11NG AT ---->>> NINE (9). 2 - ThE ELEC11ON OF DIRECTORS FROM ThE MANAGEMENT PROPOSED NOMINEES. -->>> ThE NOMINEES ARE: BRADLEY G. ThOMPSON, MATTHEW C. COFFEY, WIUJAM A. COCHRANE, JIM DINNING, ED LEVY, J. MARK IJEVONEN, ROBERT B. SCHULTZ, FRED A. STE\NART AND GER VAN AMERSFOORT. 3 -TOAPPOINTERNST&YOUNG, LIP, CHARTERED ACCOUNTANTS, AS AUDITORS OF ThE CORPORA11ON AND AUTHORIZING ThE DIRECTORS TO FIX ThEIR REMUNERA11ON. 4 - TO APPROVE AND AUTHORIZE ThE AMENDMENTS TO ThE CORPORA11ONS STOCK OP11ON PLAN TO: INCREASE ThE MAXIMUM NUMBER OF COMMON SHARES ISSUABLE PURSUANT TO ThE EXERCISE OF OP110N5 GRANTED ThEREUNDER BY 1,883,060 COMMON SHARES TO 7,653,275 COMMON SHARES; TO INCORPORATE MINOR COMMENTS FROM THE TSX TO AUGN ThE STOCK OP11ON PLAN WITh TSX REQUIREMENTS AND TO CLARIFY ThE AMENDING SEC11ONS OF ThE STOCK 0P110N PLAN, ALL AS DESCRIBED IN THE INFORMA11ON CIRCULAR OF ThE CORPORA11ON DATED MAY 14, 2012. *NOTE* ThIS FORM CONFERS DISCRE11ONARY AUThORITY TO VOTE ON SUCH OThER BUSINESS AS MAY PROPERLY COME BEFORE ThE MEE11NG OR ANY ADJOURNMENT ThEREOF. *NOTE* THIS VO11NG INSTRUC11ON FORM SHOULD BE READ IN CONJUNC11ON WITh ThE ACCOMPAN1NG INFORMA11ON CIRCULAR. VOTE USING YOUR MOBILE DATA DEVICE SUCH AS SMART PHONES AND TABLETS AT WWW.PROXYVOTE.COM ONCOLYTICS BIOTECH INC. ANNUAL AND SPECIAL MEETING To BE HELD 06/20/12 AT 04:30 P.M. EDT FOR HOLDERS AS OF 05/14/12 THIS SPACE INTENTIONALLY LEFT BLANK. VOTING HECOMMENDATIONS;0] FOR 0010110 FOR 0010112 FOR 0010200 FOR 0022402 aiiLwi (FILL IN ONLY ONE BOX”“PER ITEM IN BLUE OR BLACK INK) FOR AGMNST A/C ISSUER COPY 41 I FILL IN THE BOX I1” TO THE RIGHT IF YOU PLAN TO ATTEND AND VOTE YOUR SHARES AT THE MEETING 4 FOR WiTHHOLD Broadridge’ FOR WTTHHOLD III FOR AGAINST 51 MERCEDES WAY ED GE WOOD NY11717 ONCOLYTICS BIOTECH INC. 210-1167 KENSINGTON CRESCENT N.W. CALGARY, AB T2N 1X7 CANADA * ISSUER CONFIRMATION COPY - INFO ONLY * I I I SIGNATURE(S) DATE