Proxy Revocable

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Proxy Revocable

Proxy Revocable

{{company_name}}

{{company_address}}

Tel: {{phone}}

Email: {{email}}

Website: {{website}}

DATE: {{date}}

TO WHOM IT MAY CONCERN

SUBJECT: REVOCATION OF PROXY

Please take this as formal notification of the immediate revocation of the proxy previously granted by {{principal_name}}, with identity/company registration number {{principal_id_number}}, residing at/registered office at {{principal_address}} (hereinafter referred to as "the Principal").

DETAILS OF PREVIOUS PROXY

The proxy being revoked was granted to {{proxy_holder_name}}, with identity/company registration number {{proxy_holder_id_number}}, residing at/registered office at {{proxy_holder_address}} (hereinafter referred to as "the Former Proxy Holder").

This proxy was granted on or about {{date_of_original_proxy}} for the purpose of {{purpose_of_original_proxy}}.

EFFECTIVE DATE OF REVOCATION

This revocation is effective immediately as of {{effective_date_of_revocation}}.

The Former Proxy Holder no longer has any authority to act on behalf of the Principal in any capacity, including but not limited to the matters outlined in the original proxy document.

INSTRUCTIONS TO FORMER PROXY HOLDER

The Former Proxy Holder is hereby instructed to immediately cease and desist from exercising any powers or performing any actions under the authority of the aforementioned revoked proxy.

Any documents or property of the Principal held by the Former Proxy Holder by virtue of the original proxy must be returned to the Principal or their designated representative by {{return_by_date}}.

FURTHER NOTICE

All parties previously notified of the granting of the original proxy should consider this document as formal notification of its revocation.

Any further actions taken by the Former Proxy Holder purporting to act on behalf of the Principal will be considered unauthorized and the Principal disclaims all responsibility for such actions.

GOVERNING LAW

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

SIGNATURE

___________________________

{{principal_name}}

{{principal_title}}

On behalf of {{company_name}} (if applicable)

WITNESSES (Optional)

___________________________

Witness Name: {{witness_1_name}}

Witness Signature:

Date: {{witness_1_date}}

___________________________

Witness Name: {{witness_2_name}}

Witness Signature:

Date: {{witness_2_date}}