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VI.2.a. - Obrazac punomoci - Authoriztion Form - 04062010
A U T H O R I Z A T I O N
I, ___________________________________, born____________________________, ______________
(Name and surname) (place of birth) (date of birth)
residential address: _____________________________________________________________________
Identification document : __________________________ issued: _______________________________
(No) (date of issue)
Issued by: _____________________________________,
(Authority)
PIN (JMB)
Authorize
_____________________________ born______________________________, ___________________,
(name and surname) (place of birth) (date of birth)
from __________________________________________,
(residential address)
PIN (JMB)
to undertake the following legal actions in lieu of me:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
The Authorization expiry date:______________ Signature:
In____________________, _____________
(place) (date)
__________________________
Stamped by Notary Public