POWER OF ATTORNEY

mun. Chisinau, year two thousand fifteen __________

I, the undersigned, ________________ (___________), date of birth _______,
identification number ______________________, born in _______________, citizen of the
Republic of Moldova, male, passport No.__________________, issued on October 00,
________, _____________, authorize ___________________ (______________) date of birth
00.08.1900, identification number ______________________, citizen of the Republic of
Moldova, male, passport No.____________, issued on August 00, 0000, by 00 Chisinau, to
represent my interests in all public, administrative and competent authorities of the Republic of
Moldova, including juridical instances, registry offices, guardianship and trusteeship authorities,
etc. in respect of divorce with cit. ______________________, date of birth ____________, with
a right to submit a divorce petition on my behalf, with a right to submit on my behalf inquiries,
applications, to receive and present necessary certificates, documents, duplicates (copies), to be
my representative in all juridical instances of the Republic of Moldova, with a right to pay state
duties and right to repayment of state duties paid in excess.
In connection with this assignment, my attorney is entitled to receive
the certificate of divorce, and to affix his/her signature on the copies of
documents and to perform all other actions on my behalf related to the
execution of this assignment.
He/she may perform any actions deemed fit, as the case may be, and even those not
provided for, but limited to, this assignment; to retain a lawyer, to sign on my behalf when
necessary and to perform all actions and formalities related to this assignment.

The Power of Attorney is valid within 3 (three) years.