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14B NCAC 15A 1903 DELIVERY OF MIXED BEVERAGES PERMITTEE

Forma1

DELIVERY INSTRUCTIONS (Agent to complete)

PLEASE DELIVER THE FOLLOWING ITEM(S) TO THE UNDERMENTIONED AGENT(S)

ITEM(S)

AGENT CODE










FORM P1 (Version 4)

GUIDANCE NOTES AVAILABLE










LANDS TITLES REGISTRATION OFFICE

SOUTH AUSTRALIA

POWER OF ATTORNEY


FORM APPROVED BY THE REGISTRAR-GENERAL

SERIES NO

PREFIX


























SERIES NO

PREFIX



PA


AGENT CODE


LODGED BY:











CORRECTION TO:










SUPPORTING DOCUMENTATION LODGED WITH APPLICATION (COPIES ONLY)




1…………………………………………………………………………......




2……………………………………………………………………………..




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5……………………………………………………………………………..



























CORRECTION



ENTERED



















*Delete the inapplicable


*DUPLICATE

*ATTESTED PHOTOCOPY

DEPOSITED





DATED………………………………………





…………………………………………………………..…………..

REGISTRAR-GENERAL










POWER OF ATTORNEY

PRIVACY COLLECTION STATEMENT: The information in this form is collected under statutory authority and is used for maintaining publicly searchable registers and indexes. It may also be used for authorised purposes in accordance with Government legislation and policy requirements.

DONOR(S) (Full name and address)

SEND GREETINGS WHEREAS I am desirous of appointing an attorney to act for and represent me in Australia in all matters affairs or things in which I either solely or jointly with any other person or persons am or may be interested or concerned


NOW KNOW YE AND THESE PRESENTS WITNESS that I the ABOVEMENTIONED DONOR DO HEREBY NOMINATE CONSTITUTE AND APPOINT



DONEE(S) (Full name and address)













(*Delete the inapplicable) *JOINTLY / *JOINTLY AND SEVERALLY hereinafter called “my said Attorney”

to be my true and lawful Attorney for me and in my name or in the name of any firm under which I now or hereafter may carry on business or in the name of my said Attorney as shall appear expedient and on my part and behalf or on behalf of any such firm to act in manage and conduct all and singular the matters affairs businesses concerns or things in the Commonwealth of Australia and also in all or any of the Australian States in which I now am or may at any time hereafter be interested engaged or concerned whether solely or jointly with any other person or persons whomsoever either in my personal or private capacity or as a partner executor or trustee as fully and effectually to all intents and purposes as I myself could do if personally present and acting therein and without prejudice to or without in any way limiting or derogating from the general powers hereinbefore given I AUTHORISE AND EMPOWER my said Attorney for me and in my name or in the name of my said Attorney from time to time to do execute and perform all or any of the following acts either solely or jointly with any other person or persons:

SPECIFIC POWERS



































Page_______of __________

SPECIFIC POWERS

(continued)

Page_______of __________




DATED



IN WITNESS WHEREOF I/we the said………………………………………………….……………… (Name of Donor(s))

have hereunto set my/our hand and seal this ………………..………….DAY OF…………………………20…….









SIGNED SEALED AND DELIVERED by the said DONOR(S)

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(Signature of Donor(s))




in the presence of……………………………………………….………..………..………..………..………….

…………………………………………………………………….………..………..………..………..………..

…………………………………………………………………….………..………..………..………..…………

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(Signature of witness showing printed name and address)





















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2 FAMILY PLANNING SERVICE DELIVERY AND PROGRAMME MANAGEMENT STUDY
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