PROCURATION
Je soussigné/ I the undersigned M …………………………..…………………………………...
[Link]/Passeport Nº ……………….Délivrée le/Issued on the ……………à/at …………………
Profession/Occupation ……………………………………………………………………………..
Domicilié(e)/Resident at …………………………………………………………………………….
Adresse/Address ……………………………………………………………………………………
Donne cette procuration à/This procuration is given to ……………………………….……..
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[Link]/Passeport Nº ……………….Délivrée le/Issued on the ……………à/at …………………
Profession/Occupation ……………………………………………………………………………..
Domicilié(e)/Resident at …………………………………………………………………………….
Adresse/Address ……………………………………………………………………………………
Pour qu’il ou elle/That he or she is in charge of ………………………………………………
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En foi de quoi cette procuration lui est délivrée pour servir et valoir ce que de droit.
In testimony there of this procuration is issued.
A/at ………………le/on the…..………..
Autorité Compétente / Competent Authority