G'Day 2187,Had a handful of DLS in my bottom draw for a while...

G'Day 2187,

Had a handful of DLS in my bottom draw for a while and want to vote with you on this one. Just want to get it right before I send SO IT COUNTS.
On the front of the appointment of proxy form it is printed:

I....(my name)
of...(my address)
being a member of Drillsearch Energy Ltd entiled to vote at the meeting hereby appoint...(???) of...(???) and*** of...(???) or failing etc.

Can you assist me in understanding what I should be writing in the sections where I have ???'s please?

I have already marked all resolutions against.

Thanks in advance.

Regards,
Snake13.