EXHIBIT 99.3
Proxy Card
FREMONT MUTUAL INSURANCE COMPANY
This Proxy is Solicited by the Board of Directors for a Special Meeting of Eligible Policyholders to be
held on __________ __, 2004
The undersigned acknowledges receipt of the Proxy Statement and Notice of the Special Meeting of Eligible Policyholders of Fremont Mutual Insurance Company to be held on ____________ __, 2004, and hereby appoints Richard E. Dunning and Donald E. Bradford, or either one of them, as attorneys and proxies of the undersigned, each with full power of substitution, to cast the undersigned's vote at the Special Meeting, and at any adjournment thereof, for the purpose of acting upon the proposals referred to below, and of acting in their discretion upon such other matters as may properly come before the meeting.
Proposals: | 1. | To approve the Plan of Conversion of Fremont Mutual Insurance Company from a Michigan domiciled mutual property and casualty insurance company to a Michigan domiciled stock property and casualty insurance company. |
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| 2. | To approve the amended and restated Articles of Incorporation for Fremont Mutual Insurance Company. |
Please mark your vote as indicated in this example: x
The member hereby directs this proxy to be voted:
For | Against |
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o | o | Proposal Number 1 to approve the Plan of Conversion of Fremont Mutual Insurance Company from a Michigan domiciled mutual property and casualty insurance company to a Michigan domiciled stock property and casualty insurance company. |
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o | o | Proposal Number 2 to approve amended and restated Articles of Incorporation for Fremont Mutual Insurance Company. |
THIS PROXY WILL BE VOTED AS DIRECTED. IF NO CONTRARY DIRECTION IS INDICATED, THIS PROXY WILL BE VOTED FOR THE ABOVE PROPOSALS.
Dated:_____________________ |
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| Signature of Eligible Policyholder |
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| NOTE: Only one signature is required in the case of |
PLEASE COMPLETE, DATE, SIGN AND MAIL THIS PROXY PROMPTLY IN THE ENCLOSED POSTAGE-PAID ENVELOPE. PLEASE SIGN YOUR NAME EXACTLYAS IT APPEARS ON THIS PROXY CARD.