Proxy Revocation

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

To Whom It May Concern

This letter serves as a formal notification of the revocation of a proxy.

Details of Original Proxy

I/We, {{grantor_name}}, of {{grantor_address}}, hereby revoke the proxy granted to {{proxy_holder_name}}, of {{proxy_holder_address}}, on {{date_of_original_proxy}}.

The original proxy authorised {{proxy_holder_name}} to act on my/our behalf in relation to {{specific_purpose_of_proxy}}.

Reason for Revocation (Optional)

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

Effective Date of Revocation

This revocation is effective immediately upon the date of this letter, or as of {{effective_date_of_revocation}}, whichever is later. Any actions taken by {{proxy_holder_name}} on my/our behalf after this effective date will be considered null and void.

Confirmation of Receipt

Please acknowledge receipt of this proxy revocation by signing and returning a copy of this letter to the undersigned.

Indemnification

I/We hereby indemnify and hold harmless {{proxy_holder_name}} from any claims, demands, or liabilities arising from actions taken by {{proxy_holder_name}} in good faith prior to the effective date of this revocation.

Signature

Sincerely,

_____________________________

{{grantor_name}}

{{grantor_title_if_applicable}}

Acknowledgement of Receipt (for Proxy Holder)

I, {{proxy_holder_name}}, acknowledge receipt of this Revocation of Proxy on this {{acknowledgement_date}}.

_____________________________

{{proxy_holder_name}}