I/We hereby appoint

Power of Attorney in Civil Proceedings

as my/our Representative(s) in the case of

in the trial of the

Name of Representative :

Unit Working With :

Limit of Authority :

Name of Representative:

Unit Working With :

Limit of Authority :

Signature of Appointee :

Identity Card No.

Signature of Appointee

Identity Card No.

between

Plaintiff

and

Respondent

Instance Court.

Appointor (Unit) :

Agent Ad Litem :

Identity Card No.

Dated:

(Please note overlear)

1

7

ث الوان جد الله البهار على

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