Power of Attorney

The undersigned below:

*(principal) in this case act for and on behalf of (Company), established under the Law of (Country of
Company) by deed of establishment of Limited Liability Companies (number of deed of
establishment) made by Notary (Name of Notary) with ratification by Minister of Justice and Human
Right No. (Number of Ratification), which was published in state gazette (Number & year of state
gazette), (address of company). Hereinafter referred to as “Giving Power”.

*if the principal is a company

**

**

In this case choosing legal residence in the Attorney’s office, and explained to give the Special Power
of Attorney to:

1. (Lawyer Name)
2. (Lawyer Name)
3. (Lawyer Name) etc.

Each one as an advocate and legal consultant at the law office of (Name of law office) located at
(address of law office). Which in this case act either individually or together, hereinafter referred to
as “recipient’s Power”.

Special

To create, sign, and file a lawsuit indemnity in the (place of court) District Court against (name and
address of the company that will be sued), resulted from and act of default in executing the contract
agreement no. (numbers of contract), between the giving power and (name of company that will be
sued), on (name of contract/what contract about).

Therefore:

1. To exercise this power, recipient’s power given the right and authority to attend the court,
other judicative body, Government Officials, and Other Bodies. Submit the require request,
running the action, and perform any action in the court in accordance with the position and
the procedural law is applicable. Receive and signing the bill, receive and commit the
payment in this case. Asking decision and excecution, or fight according to the rules of law.
2. Then, perform all acts and other measures that are considered important and useful by the
RECIPIENT’S POWER for the legal interest of GIVING POWER to solve this case problems in a
way that is allowed by law, although not expressly stated in this power of attorney.

This power is given with the right of substitution and Retention.

(place, date month year)

Giving Power Recipient’s Power

Stamp 6k

(name of Giving Power) (name of attorney)

(name of attorney)

(name of attorney)