Signature of witness Sample Clauses

Signature of witness. Address of Witness

Signature of witness. Date .......................................................... I have accurately read out the explanatory letter and State School Consent Form to the potential consenter, and to the best of my ability made sure that the person understands that the following will be done:

Signature of witness. Name of witness (print) ......................................................................................Name of officer (print) ...................................................................................

Signature of witness. Name of witness (block letters)

Signature of witness. Name of witness (print) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of authorised person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signature of witness. Signature of authorised representative .................................................................

Signature of witness. Signature .......................................................................

Signature of witness. OCCUPATION ..............................................

Signature of witness. Note: 1) Failure to complete the declaration will lead to the rejection of a claim for a preference.

Signature of witness. Name of witness (block letters) .......................................................................... By executing this agreement the attorney states that the attorney has received no notice of revocation of the power of attorney <<Sub-Choice: Insert if the individual is acting as trustee>> as trustee for <name of trust> <<End Sub-Choice>> under power of attorney dated <date> in the presence of: ..........................................................................