Proxy Revocation

Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

Recipient Information

To: {{recipient_name}}

{{recipient_address}}

Subject

FORMAL REVOCATION OF PROXY

Body of Revocation

I, {{granter_name}}, residing at {{granter_address}}, hereby formally revoke and cancel any and all proxy authority previously granted to {{proxy_name}}, residing at {{proxy_address}}, to act on my behalf.

This revocation applies to the proxy granted on or about {{original_proxy_date}}, concerning {{matter_of_proxy}}.

All powers, rights, and authorities conveyed by the aforementioned proxy are hereby immediately withdrawn and terminated. {{proxy_name}} is no longer authorized to act on my behalf in any capacity whatsoever as of the date of this notice, regarding the specified matter.

Reason for Revocation (Optional)

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

Instructions to Proxy

{{proxy_name}} is hereby directed to immediately cease and desist from exercising any powers or performing any acts under the revoked proxy. Please return any documents or property related to the proxy that are in your possession to {{granter_name}} within {{number_of_days}} days of the date of this notice.

Applicable Law

This Revocation of Proxy shall be governed by and construed in accordance with the laws of {{jurisdiction}}.

Signature

Sincerely,

_____________________________

{{granter_name}}

Date: {{signature_date}}