Model form for power attorney withdrawal

POWER OF ATTORNEY WITHDRAWAL

(fill in the addressee, that is the Agent, to whom the power of attorney to be withdrawn was granted and who can be; a) Either a Corporate body i.e. company-fill in the empowered company name, company address, identification number or other identification details b) Or a Private individual-i.e. Mr Mrs.-fill in the entire names of the agent, address and any further identification where appropriate. (Hereinafter referred as the Agent) Subject: power of attorne w!t"#rawa$ %o&pan ''''''''' (fill in the company name, company address, identification number and any others identification details where appropriate) (T"e Pr!nc!pa$) w!t"#raw* "ereb w!t" an effect fro& t"e #ate''''++++++++++ t"e power of attorne , w"!c" wa* a**!gne# to t"e Agent...on #ate....!n or#er to act on t"e Pr!nc!pa$-* be"a$f!!!!....(specify here what actions and to what e"tent the agent was authori#ed to act). P$ace'''''''Date''''''' .. Na&e an# *urna&e !n b$oc. cap!ta$* an# "!*/"er *!gnature ($ignature must be notari#ed. %ower of attorney withdrawal must be signed by a person authori#ed to act on the %rincipal&s behalf, eg. E"ecuti'e, company manager, assigned person, appointees, board member ect.) Attent!on note: T"e Pr!nc!pa$, !+e+, t"at !* t"e part to be acte# for, can not effect!0e$ wa!0e t"e r!g"t to w!t"#raw t"e power of attorne at an t!&e !n a#0ance+ It !* t"e Pr!nc!pa$-* ob$!gat!on to not!f t"e Agent of t"e power of attorne w!t"#rawa$+ T"e power attorne w!t"#rawa$ !* not effect!0e, unt!$ t"e Agent !* #u$ not!f!e#, !+e+ t"e $ega$ act* of t"e Agent "a0e effect*, a* !f t"e power of attorne wa* &a!nta!ne#+

((enerally, attached should be a statement of the Agent, where he she states, that he she is familiar with the power of attorney withdrawal, together with a date and a signature of the Agent) Either a Corporate body- i.e. company-fill in empowered company name, company address , identification number and other identification details Or a Private individual-i.e. Mr. Mrs. )the entire name of the Agent, address and any future identification details shall be pro'ided. I "ereb ac.now$e#ge t"e w!t"#rawa$ of t"e power of attorne !**ue# on #ate''''''++for''''''''''''++ (details of the actions and the e"tent the Agent was authori#ed to act)

PlaceDate (Name, surname in loc! capitals, "i#nature)