Exhibit 99.4
 | Cynapsus Therapeutics Inc. (the “Corporation”)
FORM OF PROXY (“PROXY”) Warrantholders
Special Meeting October 13, 2016 at 10 a.m. (Toronto Time) Borden Ladner Gervais LLP, Scotia Plaza 40 King Street West, Suite 4400 Toronto, Ontario, Canada, M5H 3Y4 (the “Meeting”) |
| RECORD DATE: | September 9, 2016 | |
| CONTROL NUMBER: | ||
| SEQUENCE #: | ||
| FILING DEADLINE FOR PROXY: | October 11, 2016 at 10 a.m. (Toronto Time) | |
| VOTING METHOD | ||
| INTERNET | Go towww.voteproxyonline.com and enter the 12 digit control number above | |
| FACSIMILE | (416) 595-9593 | |
| MAIL or HAND DELIVERY | TSX Trust Company 200 University Avenue, Suite 300, Toronto, Ontario, M5H 4H1 | |
| The undersigned hereby appointsAnthony Giovinazzo,President and Chief Executive Officer of the Corporation, failing whomAndrew Williams, Chief Operating Officer and Chief Financial Officerof the Corporation, (the “Management Nominees”), or instead of any of them, the following Appointee |
| Please print appointee name |
| as proxyholder on behalf of the undersigned with the power of substitution to attend, act and vote for and on behalf of the undersigned in respect of all matters that may properly come before the Meeting and at any adjournment(s) or postponement(s) thereof, to the same extent and with the same power as if the undersigned were personally present at the said Meeting or such adjournment(s) or postponement(s) thereof in accordance with voting instructions, if any, provided below. |
| - SEE VOTING GUIDELINES ON REVERSE - |
| RESOLUTIONS – MANAGEMENT VOTING RECOMMENDATIONS ARE INDICATED BYHIGHLIGHTED TEXT ABOVE THE BOXES |
| 1. Special Resolution | FOR | AGAINST | ||
| A special resolution, the full text of which is set forth in Appendix A to the management information circular of Cynapsus Therapeutics Inc. dated September 15, 2016 (the “Information Circular”), approving an arrangement under section 192 of the Canada Business Corporations Act, all as more particularly described in the Information Circular. | ¨ | ¨ |
| This proxy revokes and supersedes all earlier dated proxies andMUST BE SIGNED | |||
| PLEASE PRINT NAME | Signature of registered owner(s) | Date (MM/DD/YYYY) | |
Proxy Voting – Guidelines and Conditions
| 1. | THIS PROXY IS SOLICITED BY MANAGEMENT OF THE CORPORATION. |
| 2. | THIS PROXY SHOULD BE READ IN CONJUNCTION WITH THE MEETING MATERIALS PRIOR TO VOTING. |
| 3. | If you appoint the Management Nominees to vote your securities, they will vote in accordance with your instructions or, if no instructions are given, in accordance with the Management Voting Recommendations highlighted for each Resolution on the reverse. If you appoint someone else to vote your securities, they will also vote in accordance with your instructions or, if no instructions are given, as they in their discretion choose. |
| 4. | This proxy confers discretionary authority on the person named to vote in his or her discretion with respect to amendments or variations to the matters identified in the Notice of the Meeting accompanying the proxy or such other matters which may properly come before the Meeting or any adjournment or postponement thereof. |
| 5. | Each security holder has the right to appoint a person other than the Management Nominees specified herein to represent them at the Meeting or any adjournment or postponement thereof. Such right may be exercised by inserting in the space labeled “Please print appointee name”, the name of the person to be appointed, who need not be a security holder of the Corporation. |
| 6. | To be valid, this proxy must be signed. Please date the proxy. If the proxy is not dated, it is deemed to bear the date of its mailing to the security holders of the Corporation. |
| 7. | To be valid, this proxy must be filed using one of theVoting Methods andmust be received by TSX Trust Companybefore theFiling Deadline for Proxies, noted on the reverse or in the case of any adjournment or postponement of the Meeting not less than 48 hours (Saturdays, Sundays and holidays excepted) before the time of the adjourned or postponed meeting. Late proxies may be accepted or rejected by the Chairman of the Meeting in his discretion, and the Chairman is under no obligation to accept or reject any particular late proxy. |
| 8. | If the security holder is a corporation, the proxy must be executed by an officer or attorney thereof duly authorized, and the security holder may be required to provide documentation evidencing the signatory’s power to sign the proxy. |
| 9. | Guidelines for proper execution of proxy available atwww.stac.ca. Please refer to the Proxy Protocol. |
Proxy Voting – Guidelines and Conditions
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