If you have appointed more than one agent and you want each agent to be able to act alone without the other agent joining, write the word “separately” in the blank space above. If you leave the space blank, or if you enter the work “jointly,” then all of your agents must act or sign together on your behalf.
I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney.
[Sender.FirstName][Sender.LastName]
[Sender.Country][Sender.State]
By accepting or acting under the appointment, the Agent assumes the fiduciary and other legal responsibilities of an agent.
A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
CERTIFICATE OF ACKNOWLEDGEMENT OF NOTARY PUBLIC
State of California
County of (Insert Country)
On (date) before me, [Notary.FirstName][Notary.LastName], personally appeared (Principal Name), who provided to me onthe basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.