Acknowledgement re Power of Attorney

I refer to the Power of Attorney dated [Date of Power of Attorney (ie. September 20, 2002)]
whereby I appointed [Name of Attorney] to be my attorney and to do on my behalf anything that
I can lawfully do by an attorney except to make a will or testament.

1. I hereby acknowledge that:

(a) I am familiar with the kind of property I own and its approximate value;

(b) I am aware of the obligations I owe to my dependants;

(c) I know that my Attorney will be able to do on my behalf anything in respect of

property that I could do if capable, except make a will, subject to the conditions
and restrictions set out in the Power of Attorney;

(d) I know that my Attorney must account for his or her dealings with my property;

(e) I know that I may, if capable, revoke the Power of Attorney;

(f) I appreciate that unless my Attorney manages my property prudently, its value
may decline; and

(g) I appreciate the possibility that my Attorney could misuse the authority given to
him or her.

2. I hereby further acknowledge that I am at least eighteen years old.

DATED this _____ day of ____________________, 19___

Witness [Name of Donor of Power of Attorney]