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POWER OF ATTORNEY

(Mandate convention)

I, the undersigned

.......................................................................................................................

(name and surname)

residing in

.......................................................................................................................

(complete address)

...
...

national of

...

Passport no
issued in

valid until ....


by ....
authorise

Mister / Madam

..................................................................

(name and surname)

residing in

........................................................................................................................

(exact address)

....

national of

...

Passport no
issued in

valid until ........


by .

to receive in my name the authorisation to reside, which will be issued by the Ministry for
Foreign Affairs, Directorate of Immigration, Department for foreigners, if all conditions
are fulfilled.

Signed in .. on .
to whom it may concern.
The constituent

The delegate

_______________
(signature)

_______________
(signature preceded by good for power of
attorney )

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