Subscription Form and Power of Attorney

{{company_name}}

{{company_address}}

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

Subscription Form and Power of Attorney

Subscription Form and Power of Attorney

{{company_name}} {{company_address}} Tel: {{phone}} Email: {{email}} Website: {{website}}

SUBSCRIPTION FORM AND POWER OF ATTORNEY

This Subscription Form and Power of Attorney (hereinafter referred to as 'this Agreement') is made and entered into on this the {{day}} day of {{month}}, {{year}}, by and between:

1. {{subscriber_name}} (hereinafter referred to as 'the Subscriber'), residing at/with its registered office at {{subscriber_address}}, and

2. {{company_name}} (hereinafter referred to as 'the Company'), with its registered office at {{company_address}}.

1. SUBSCRIPTION DETAILS

1.1. The Subscriber hereby subscribes for the following:

Service/Product: {{service_product_name}}

Subscription Type: {{subscription_type}}

Subscription Period: {{subscription_period}}

Commencement Date: {{commencement_date}}

Subscription Fee: {{currency}} {{subscription_fee}}

Payment Frequency: {{payment_frequency}}

2. SUBSCRIBER INFORMATION

2.1. Full Name/Company Name: {{subscriber_full_name}}

2.2. Identity/Registration Number: {{id_registration_number}}

2.3. Contact Person (if applicable): {{contact_person}}

2.4. Contact Number: {{contact_number}}

2.5. Email Address: {{email_address}}

2.6. Billing Address: {{billing_address}}

3. TERMS AND CONDITIONS OF SUBSCRIPTION

3.1. The Subscriber acknowledges that they have read, understood, and agree to be bound by the terms and conditions of the subscription service/product as provided by the Company, typically attached as Annexure 'A' or available on the Company's website at {{company_website_terms_link}}.

3.2. The Subscriber agrees to pay the subscription fees as specified in Section 1, in accordance with the agreed payment frequency.

3.3. Failure to make timely payments may result in the suspension or termination of the subscription service/product.

4. POWER OF ATTORNEY

4.1. The Subscriber hereby irrevocably nominates, constitutes, and appoints {{attorney_name}} of {{attorney_address}} (hereinafter referred to as 'the Attorney'), with full power of substitution, to be the Subscriber's true and lawful attorney and agent, to act for and on behalf of the Subscriber and in their name, place, and stead, to do, perform, and execute all or any of the acts, deeds, matters, or things relating to the subscription service/product mentioned herein, including but not limited to:

4.1.1. Signing all necessary documents, forms, and agreements pertaining to the subscription.

4.1.2. Making payments, receiving statements, and engaging in correspondence related to the subscription.

4.1.3. Representing the Subscriber in any discussions, negotiations, or disputes concerning the subscription.

4.1.4. Instituting or defending any legal proceedings in connection with the subscription.

4.2. This Power of Attorney shall remain in full force and effect until such time as it is revoked in writing by the Subscriber and such revocation is duly received and acknowledged by the Company and the Attorney.

4.3. The Subscriber undertakes to ratify and confirm all that the Attorney may lawfully do or cause to be done by virtue of this Power of Attorney.

5. INDEMNITY

5.1. The Subscriber hereby indemnifies and holds harmless the Company, its directors, officers, employees, and agents from and against any and all claims, liabilities, losses, damages, costs, and expenses (including legal fees) arising from or in connection with the subscription service/product or the exercise of the Power of Attorney granted herein, except in cases of gross negligence or willful misconduct by the Company or the Attorney.

6. GOVERNING LAW AND JURISDICTION

6.1. This Agreement shall be governed by and construed in accordance with the laws of {{country}}.

6.2. The parties hereto consent to the non-exclusive jurisdiction of the {{court_name}} in respect of any dispute arising out of or in connection with this Agreement.

7. GENERAL PROVISIONS

7.1. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior discussions, negotiations, and agreements, whether oral or written.

7.2. No amendment or variation of this Agreement shall be valid or binding unless reduced to writing and signed by both parties.

7.3. Headings are for convenience only and shall not affect the interpretation of this Agreement.

SIGNATURES

THUS DONE AND SIGNED at {{city}} on this the {{signature_day}} day of {{signature_month}}, {{signature_year}}.

_____________________________

SUBSCRIBER/Duly Authorised Representative

Name: {{subscriber_signature_name}}

Capacity: {{subscriber_capacity}}

AS WITNESSES:

1. _________________________

Name: {{witness_1_name}}

2. _________________________

Name: {{witness_2_name}}

_____________________________

FOR AND ON BEHALF OF {{company_name}}

Name: {{company_representative_name}}

Capacity: {{company_representative_capacity}}