SPECIAL POWER OF ATTORNEY

BY THIS POWER OF ATTORNEY executed at on , 2015, I, , aged years, son/daughter of , do hereby nominate, constitute and appoint of Attorney, son/daughter of , resident of ,to be my true and lawful attorney and, on my behalf, to do or execute attorney to do the following acts, deeds, matters and things and execute the following powers with respect to:



And I hereby agree to ratify whatever is done or caused to be done by the said Attorney on my behalf by virtue of this Power hereby given but not of the default of or of his/her/their legal heir(s), executor(s) or assign(s).
THIS POWER OF ATTORNEY shall be in full force and effect on the date below written, and shall remain in full force and effect until , or unless specifically extended or rescinded earlier by either party.
IN WITNESS WHEREOF, I, Name of the person making Power of Attorney , have executed this Special Power of Attorney on the above-written date.
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IN WITNESS WHEREOF, I, , have executed this Power of Attorney on the below written date.
SIGNED AND DELIVERED by the within named.
Witnesses:
1.__________________________
Name:
Address:
2. ___________________________
Name:
Address:
IDENTIFIED BY ME BEFORE ME