Ordinary Power of Attorney

GENERAL POWER OF ATTORNEY

(section 10 of the Powers of Attorney Act 1971)

DATED

______ (DAY) ___________ (MONTH) _________ (YEAR)

1. Governing law and Jurisdiction

Any dispute or claim arising out of or in connection with this power of attorney will be governed by and construed in accordance with the laws of England and Wales. The courts of England and Wales will have the exclusive jurisdiction to settle any dispute or claim arising out of this power of attorney.

2. Creation of power

This general power of attorney is made on _______(DAY) __________ (MONTH) _________ (YEAR) by ________ of:

________.

3. Appointment and powers

I appoint:

________

of ________

as my attorney (my Attorney) in accordance with section 10 of the Powers of Attorney Act 1971.

4. Duration

This power of attorney shall remain in force until its expiration on ________.

EXECUTED AS A DEED ON THE DATE SET OUT AT THE BEGINNING OF THIS DEED

EXECUTED AND DELIVERED

AS A DEED

BY

________

SIGNATURE:

_____________________________

IN THE PRESENCE OF

WITNESS NAME:

_____________________________

WITNESS SIGNATURE:

_____________________________

ADDRESS:

_____________________________

_____________________________

_____________________________

OCCUPATION:

_____________________________