FORM NO. 2B
POWER OF ATTORNEY

I/We

Address

1. Authorize

To represent me(us) for:

All applications

Application No.

(check or fill the applicable box)

Before BELIPO

Place

Date

2. Signature

Email (required)

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  1. State full name and address of agent.
  2. The application may be signed by printing, completing and faxing or attaching the FACSIMILE SIGNATURE FORM, or using any combination of letters, numbers, spaces or punctuation marks placed between two forward slash ("/") symbols. Examples of acceptable signatures for electronic application forms include /john doe/, /drl/, and /577-34567/ (Section 9 of CAP.290:01 read with Paragraph 2 of A.I. No. 6 of 2005). An applicant must notify the Office of his particular method of electronic signature.