EX-99.3 4 d353592dex993.htm EXHIBIT 99.3 Exhibit 99.3

Exhibit 99.3

 

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9th Floor, 100 University Avenue

Toronto, Ontario M5J 2Y1

www.computershare.com

 
   

Security Class

 

Holder Account Number

 

 

        

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Form of Proxy - Annual and Special Meeting to be held on June 20, 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.

 

 

        

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8.      This proxy should be read in conjunction with the accompanying documentation provided by Management.

 

Proxies submitted must be received by 4:30 pm, Eastern Time, on Monday, June 18, 2012.

VOTE USING THE TELEPHONE OR INTERNET 24 HOURS A DAY 7 DAYS A WEEK!

 

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•   Call the number listed BELOW from a touch tone telephone.

 

•   Go to the following web site:

www.investorvote.com

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1-866-732-VOTE (8683) Toll Free

 

 

•   Smartphone?

Scan the QR code to vote now.

    

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

  

 

    17AP12130.E.sedar/000001/000001/i


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Appointment of Proxyholder

 

I/We, being holder(s) of Oncolytics Biotech Inc. (the “Corporation”) hereby appoint: Bradley G. Thompson, or failing him, Douglas A. Ball        OR        Print the name of the person you are appointing if this person is someone other than the Management Nominees listed herein.      
       

 

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 and Special Meeting of shareholders of Oncolytics Biotech Inc. to be held at the Hilton Toronto, 145 Richmond Street West, Toronto, ON, M5H 2L2 on Wednesday, June 20, 2012 at 4:30 pm, Eastern Time, and at any adjournment or postponement thereof.   

 

VOTING RECOMMENDATIONS ARE INDICATED BY HIGHLIGHTED TEXT OVER THE BOXES.

 

     For    Against    
1. Fix the Number of Directors    ¨    ¨  

To fix the number of directors to be elected at the meeting at nine (9).

 

       
     For    Withhold    
2. Election of Directors        

        

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The election of directors from the Management proposed nominees. The nominees are: Bradley G. Thompson, Matthew C. Coffey, William A. Cochrane, Jim Dinning, Ed Levy, J. Mark Lievonen, Robert B. Schultz, Fred A. Stewart and Ger van Amersfoort.    ¨    ¨  

Vote FOR or WITHHOLD for all nominees proposed by Management

 

       
     For    Withhold    
3. Appointment of Auditors    ¨    ¨  

To appoint Ernst & Young, LLP, Chartered Accountants, as Auditors of the Corporation and authorizing the Directors to fix their remuneration.

 

       
     For    Against    
4. Amendment to the Stock Option Plan        
To approve and authorize the amendments to the Corporation’s Stock Option Plan to: increase the maximum number of common shares issuable pursuant to the exercise of options granted thereunder by 1,883,060 common shares to 7,653,275 common shares; to incorporate minor comments from the TSX to align the Stock Option Plan with TSX requirements and to clarify the amending sections of the Stock Option Plan, all as described in the Information Circular of the Corporation dated May 14 2012.    ¨    ¨  
       

        

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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 Management’s Discussion and Analysis by mail.

  ¨          Annual Financial Statements - Mark this box if you would NOT like to receive the Annual Financial Statements and 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.  

 

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