Speciaal volmachtformulier
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CONTENT SPECIAL POWER OF ATTORNEY REVOCABLE THIS SPECIAL POWER OF ATTORNEY is executed at on this day of by presently residing at , , hereinafter referred to as the Executant .. NOW, THEREFORE, BY THESE PRESENTS, I/We, Mrs. Mr. the above named Executant, do hereby jointly severally nominate, authorize constitute and appoint Mr/s.wife/daughter/son of Mr/s. resident of , as my/our true and lawful attorney, hereinafter referred to as the Said Attorney , in fact and in law for me/us and in my/our name and on my/our behalf for the purposes mentioned hereinabove and particular this is to say:
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