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Get Canada 22-053-126 2010

Title Titre Signature Date Year Ann e The above named firm or individual hereby authorizes representatives whose signatures appear below to receive parcel and letter mail for which signature may or may not be required addressed to or in care of the above named individual or firm until otherwise notified in writing. Any previous authorizations are hereby revoked. Authorized Representatives Repr sentants autoris s La section ci-apr s doit tre remplie par la personne qui pr sente ce formulaire en pr sence d un employ charg de la livraison ou d un pr pos la vente au d tail. Cette personne doit tre un repr sentant autoris dont le nom figure plus haut ou la personne accordant l autorisation. Signature of clerk witnessing Signature du pr pos t moin Customer s signature de la signature du client Type of ID verified Pi ce d identit v rifi e 22-053-126 09-10 MM DJ This form duly completed is to be retained on file at the designated post office for the address indicated. Par la pr sente l entreprise ou la personne susmentionn e autorise les repr sentants dont la signature figure ci-apr s recevoir colis et courrier poste-lettres pour lesquels une signature peut tre requise ou non adress s la personne ou l entreprise ou exp di s aux soins de l une ou l autre de ces derni res jusqu avis contraire mis par crit. Toute autorisation pr c dente est r voqu e par la pr sente. Nom en lettres moul es The section below is to be completed by the individual submitting this form in the presence of a Canada Post delivery employee or Retail postal clerk. Letter of Authorization Lettre d autorisation Name of Individual or Business/Organization Nom de la personne de l entreprise ou de l organisme Telephone No* N de t l phone Address Adresse Prov* City Ville Authorization granted by Individual with authority to sign on behalf of the business/organization named above. If this authorization is on behalf of an individual the authorized by signature must be that of the individual named at the top of the form no title required. Printed Name Nom en lettres moul es Postal Code Code postal Autorisation accord e par la personne autoris e signer au nom de l entreprise ou de l organisme susmentionn. Si cette autorisation est accord e au nom d une personne la signature figurant sous Signature accord e par doit tre celle de la personne nomm e au haut du formulaire le titre n est pas n cessaire. Title Titre Signature Date Year Ann e The above named firm or individual hereby authorizes representatives whose signatures appear below to receive parcel and letter mail for which signature may or may not be required addressed to or in care of the above named individual or firm until otherwise notified in writing. Any previous authorizations are hereby revoked* Authorized Representatives Repr sentants autoris s La section ci-apr s doit tre remplie par la personne qui pr sente ce formulaire en pr sence d un employ charg de la livraison ou d un pr pos la vente au d tail* Cette personne doit tre un repr sentant autoris dont le nom figure plus haut ou la personne accordant l autorisation* Signature of clerk witnessing Signature du pr pos t moin Customer s signature de la signature du client Type of ID verified Pi ce d identit v rifi e 22-053-126 09-10 MM DJ This form duly completed is to be retained on file at the designated post office for the address indicated* Par la pr sente l entreprise ou la personne susmentionn e autorise les repr sentants dont la signature figure ci-apr s recevoir colis et courrier poste-lettres pour lesquels une signature peut tre requise ou non adress s la personne ou l entreprise ou exp di s aux soins de l une ou l autre de ces derni res jusqu avis contraire mis par crit. .

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