Proxy Revocable

Letterhead

{{company_name}}

{{company_address}}

Tel: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

To Whom It May Concern

Subject: Revocation of Proxy

Details of Proxy Being Revoked

I/We, {{your_name/company_name}}, residing at/with registered office at {{your_address/registered_address}}, do hereby formally revoke all and any proxies previously granted by me/us, specifically but not limited to, the proxy granted to:

Proxy Holder Name: {{proxy_holder_name}}

Proxy Holder Address: {{proxy_holder_address}}

Date of Original Proxy Grant: {{original_proxy_date}}

Purpose of Original Proxy Grant: {{purpose_of_original_proxy}}

Declaration of Revocation

This revocation is effective immediately and supersedes any and all prior proxy appointments made by me/us to the aforementioned proxy holder. All authority, power, and rights previously conferred upon the said proxy holder are hereby withdrawn and cancelled.

Any actions taken by the aforementioned proxy holder on my/our behalf after the date of this revocation shall be null and void and without my/our authority.

Reason for Revocation (Optional)

The reason for this revocation is: {{reason_for_revocation}}

Acknowledgement

I/We request that all relevant parties be informed of this revocation promptly. A copy of this revocation has been sent to the proxy holder.

Signature

Sincerely,

_____________________________

{{your_name/authorized_signatory_name}}

{{your_title/capacity}}

{{company_name}} (if applicable)