Full Name of Officer:

Test Name All Good

Officer Email Address:

laddbox@yahoo.com

Date Prepared:

31 December 2022

GNSO Organization:

Internet Services Provider Constituency

Officer Position or Title:

title test

Name of Absent Councilor:

Name

Voting Remedy:

Proxy

Proxy Information

Reason(s) for or condition(s) leading to the remedy:

Proxy reason

Specific subject(s)/measure(s)/motion(s)/action(s) of the Council for which the remedy is being exercised:

Proxy remedy

Date upon which the remedy will expire or terminate:

31 December 2041

I affirm that a voting position has been established on the matter(s) at issue pursuant to provisions contained in our Charter or Bylaws.

No

Our GNSO Councilor has been instructed on how to vote on the matter(s).

Yes

Full Name of GNSO Councilor Serving as Voting Proxy:

Full Name

By submitting my personal data, I agree that my personal data will be processed in accordance with the ICANN Privacy Policy, and agree to abide by the website Terms of Service.

I Agree