POWER OF ATTORNEY APPLICATION FORM

Power of Attorney

INFORMATION'S

I the undersigned, Mr./Mrs./Ms.*

Born on(date of birth)*

In (place of birth)*

Bearer of Cameroonian passport N*

Issued on*

In*

Residing at (complete address)*

Phone number *:

Email address *:

INFORMATION'S

Grant this power of attorney to Mr./Mrs./Ms.*

Born on(date of birth)*

In (place of birth)*

Bearer of*

Other*

Issued on*

In*

INFORMATION'S

Residing at (complete address)*

Phone number *:

Email address *:

To enable him/her to *: