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PROCURATION

Je soussign M ____________________________________________________________________
CNI No._________________________________.Dlivre le_____________._________________
N le ___________________________________________________________________________
Fils ou fille de______________________________.et de__________________________________
Demeurant ______________________________________________________________________
Profession _______________________________________B.P______________________________
Donne procuration M____________________________________________________________
CNI No._________________________________.Dlivre le_____________ _________________
N le ___________________________________________________________________________
Fils ou fille de_______________________________.et de__________________________________
Pour quil ou elle soccupe de _________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
En foi de quoi cette procuration lui est dlivre pour servir et valoir ce que de droit

Fait ._______________________ le_____________________

Autorit comptente