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Blackline Safety Corp. — Proxy Solicitation & Information Statement 2021
Mar 4, 2021
46025_rns_2021-03-03_b1b3003a-09fa-4bc6-8ff4-c1c05514596a.pdf
Proxy Solicitation & Information Statement
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Mr A Sample Designation (if any) Add1 Add2 add3 add4 add5 add6
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8th Floor, 100 University Avenue Toronto, Ontario M5J 2Y1 www.computershare.com
Security Class COMMON SHARES
Holder Account Number
C1234567890 XXX
Form of Proxy - Annual General and Special Meeting to be held on Tuesday, March 30, 2021
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).
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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.
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This proxy should be signed in the exact manner as the name(s) appear(s) on the proxy.
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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.
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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.
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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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This proxy should be read in conjunction with the accompanying documentation provided by Management.
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Proxies submitted must be received by 3:00 pm, MDT, on Friday, March 26, 2021.
VOTE USING THE TELEPHONE OR INTERNET 24 HOURS A DAY 7 DAYS A WEEK!
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To Vote Using the Telephone
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Call the number listed BELOW from a touch tone telephone.
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1-866-732-VOTE (8683) Toll Free
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To Vote Using the Internet
To Virtually Attend the Meeting
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Go to the following web site: • You can attend the meeting virtually by www.investorvote.com visiting the URL provided on the back of this proxy.
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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 123456789012345
CPUQC01.E.INT/000001/i1234
01OY2A
C1234567890
MR SAM SAMPLE
XXX 123
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Appointment of Proxyholder
I/We being holder(s) of common shares of Blackline Safety Corp. (the “Corporation”) hereby appoint(s): Cody Slater, the Chief Executive Officer of the Corporation, or failing him, Shane Grennan, Chief Financial Officer of the Corporation (collectively, the “ Management Nominees ”)
Print the name of the person you are appointing if this person is someone OR other than the Management Nominees listed herein.
Note: If completing the appointment box above and your appointee intends on attending online YOU MUST go to https://www.computershare.com/Blackline and provide Computershare with the name and email address of the person you are appointing. Computershare will use this information ONLY to provide the appointee with a user name to gain entry to the online 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 Blackline Safety Corp. to be held virtually at https://web.lumiagm.com/214612831 on Tuesday, March 30, 2021 at 3:00 pm, MDT and at any adjournment or postponement thereof (the “ Meeting ”).
VOTING RECOMMENDATIONS ARE INDICATED BY HIGHLIGHTED TEXT OVER THE BOXES.
| For | Against | |||
|---|---|---|---|---|
| 1. | Number of Directors | |||
| T | f th b f dit f th Cti t b ltd t th Mti t 7 dit | Fold |
To fix the number of directors of the Corporation to be elected at the Meeting at seven (7) directors.
2. Election of Directors
The election of the directors as nominated by management of the Corporation in the accompanying management information circular and proxy statement dated February 23, 2021 prepared for the purpose of the Meeting (“ Management Information Circular ”).
| For | Withhold | Withhold | For | Withhold | For | Withhold | |||
|---|---|---|---|---|---|---|---|---|---|
| 01. Cody Slater | 02. Michael Hayduk | 03. John Finbow | |||||||
| 04. Robert Herdman | 05. Brad Gilewich | 06. Cheemin Bo-Linn | |||||||
| 07. Barbara Holzapfel | |||||||||
| For | Withhold | ||||||||
| 3. Appointment of Auditors | |||||||||
| The appointment of PricewaterhouseCoopers LLP as Auditors of the Corporation for the ensuing year and authorizing the Board Corporation to fx their remuneration. |
of Directors of the | ||||||||
| For | Against | ||||||||
| 4. Re-approval of the Stock Option Plan | |||||||||
| To pass an ordinary resolution, as more particularly set forth in the Management Information Circular, re-approving the stock option plan of the Corporation. | |||||||||
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5. Conditional Amendment of Stock Option Plan
To pass an ordinary resolution, as more particularly set forth in the Management Information Circular, approving the amendment and restatement of the Corporation’s stock option plan effective as of (and conditional upon) the listing of the common shares of the Corporation on the Toronto Stock Exchange.
6. By-Law Amendment
To pass an ordinary resolution, as more particularly set forth in the Management Information Circular, approving the amendment of the Corporation’s by-laws to permit shareholder meetings to be held by electronic means.
Authorized Signature(s) – This section must be completed for your instructions to be executed.
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.
Signature(s) Date MM / DD / YY
Interim Financial Statements – Mark this box if you Annual Financial Statements – Mark this box if would like to receive Interim Financial Statements and you would NOT like to receive the Annual Financial accompanying Management’s Discussion and Analysis Statements and accompanying Management’s Discussion by mail. 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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