ADESA AUCTIONS CANADA CORPORATION OPENLANE CANADA INC On Behalf of their Subsidiaries and Affiliates POWER OF ATTORNEY BRITISH COLUMBIA – BROKER TO: Reliance Insurance Agencies ADDRESS: Suite 324 - 2800 East 1st Ave, Vancouver, street name & no. FROM: (“Broker”)
Vancouver British Columbia V5M 4P4 City/town province postal code
(“Customer”)
ADDRESS: street name & no. City/town province postal code
1) For value received, the Customer hereby appoints the Broker to be its attorney in respect of all matters pertaining to vehicle registration/licensing/insurance and/or transfer purposes only, for all vehicles owned by or under the legal control of the Customer. 2) The Broker is authorized and directed to rely upon this Power of Attorney. This Power of Attorney may be exercised during any subsequent legal incapacity of the Customer. This Power of Attorney will remain binding on the Customer until written notice of its revocation is actually received by the Broker. DATED AT THE MUNICIPALITY OF DAY OF ________, 20 . , IN THE PROVINCE OF BRITISH COLUMBIA, THIS IN THE PRESENCE OF: Witness #1 Signature of Witness #1 Name Address Line 1 Address Line 2 Witness #2 Signature of Witness #2 Name )
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) [INSERT GRANTOR’S FULL LEGAL NAME HERE]
Signature of Authorized Representative of Grantor
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) Address Line 2 )
Address Line 1 20120823 BC Broker POA FORM 1 of 2
If the Grantor is an individual the following certificate must be completed by a Notary Public. Certificate of Notary Public I HEREBY CERTIFY THAT: 1.
___________________________________ of ________________________ in the Province of British Columbia, the Grantor named in the Power of Attorney dated_______________ naming ADESA AUCTIONS CANADA CORPORATION and OPENLANE Canada Inc as his/her attorney, which this certificate is noted on, appeared in person before me and acknowledged that he had executed the Power of Attorney; 2.
I satisfied myself by examination of him/her that he/she is aware of the contents of the Power of Attorney and understands it. GIVEN at ____________________ this ______day of _______________, 20_______ under my hand and seal of my office. A Notary Public in and for the Province of British Columbia
(SEAL) STATEMENT OF GRANTOR I am the person named in this Certificate. Signature of Grantor
20120823 BC Broker POA FORM 2 of 2