Power of Attorney Application Form

Power of Attorney Application Form
Name and Surname of the Principal: ________________________________________________
Name of the Mother: ____________________________________________________________
Date and place of birth: ______________________________________________
Place and registration number: _________________________________________
Name and Surname of the Agent: __________________________________________________
Name of the Mother: ____________________________________________________________
Date and place of birth: ______________________________________________
Place and registration number: _________________________________________
Nationality of the agent: ______________________________________________
Type of Power Attorney: General – Special – Judicial – Annulment of a power of attorney
– Renunciation
Subject of the POA: _____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Address in the UK: ______________________________________________________________
______________________________________________________________
Phone number: _________________________________________________