Fillable Printable Revocation of Power of Attorney - Canada Student Aid Alberta

Revocation of Power of Attorney - Canada Student Aid Alberta

July 2015

REVOCATION of Power of Attorney

For Student Aid Alberta

Instructi on Sheet for Students

If you have assigned a Power of Attorney authorizing someone else to have acces s to your personal

information or t o act on your behalf on matters concerning your Alberta student aid, t he Power of

Attor ney remains in ef f ect for five years from the date you sign it, or until it is terminated in accordance

with clause 4 of the Power of Attorney. If you decide to r evok e (cancel) your Power of Attor ney you

must give written notice to your appoint ed attorney and Innovation and Advanc ed Educat ion. If you

do not advise your attorney that you have revoked the Power of At torney, you may be held

responsible for the acts of y our attorney.

Once you have revoked the Power of Attorney and informed your attorney, the att or ney can no longer

rely on the Power of Att orney. If your at torney c ontinues to act on your behalf, the att orney may be

held personally responsible f or the attorney’s acts.

Key definitions to help you fill out the form correctly

Who is the "donor"? The "donor" is you, the student. You must revoke the Power of Attorney in

writing and you must be m ent ally capable of understanding the nature and effect of the revocation on

the date it is signed. If you are physically unable to sign the revocation, another person may sig n on

your behalf at your direction, and in the presence of both yourself and the witnesses. Your attorney or

the spouse or adult interdependent partner of the attorney cannot sign on your behalf.

Who is the "attorney "? The "attorney" is the person you designated and authorized to act on your

behalf.

Who is the "witness"? The "wit ness" can be anyone except for the following:

• A person under the ag e of 18 years of age;

• The person designated as your attorney;

• The spouse or adult interdependent partner of the person desig nated as your attorney;

• The person, or the spouse or adult interdependent partner of the person, signing the

Revocation of Power of Attorney on your behalf if you are physically unable to sign the

Revocation of Power of Attorney; or

• You, your spouse or adult interdependent partner, your child or person treated as your child.

Easy steps to complete the Revocation of Power of Attorney form

1. Print and read this form.

2. Complete the donor’s name and address. (Your leg al name and address.)

3. Complete the attorney’s name and address. (This is the per s on you designated and

authorized to act on your behalf .)

4. Sign the Revocation of Power of Attor ney form in the presence of t wo witnesses (s ee above

restrictions on who can be a witness).

5. Have both wit ness es s ign and complete the Revocation of Power of Attorney form in your

presence and each other’s pr es ence.

6. Make phot oc opies of the form and distribute as f ollows:

a) the original copy to your attorney

b) keep one copy for your records

7. Submit the form to Student Aid Alberta:

• Send documents electronically: 1. Visit studentaid.alberta.ca 2. Sign in via SFS Login

3. Submit securely using e-Document Upload.

• Or mail to: St udent Aid Alberta, PO Box 28000 Stn Main Edm AB T5J 4R4

Questions?

This Revocation of Power of Attorney has been prepared for your convenience and the Government of Alberta

makes no representation whatsoever about the form, usability, or validity of this Revocation of Power of

Attorney. For general questions with respect to submission of this document, contact the Student Aid Alberta

Service Centre toll free at 1-855-606-2096 from anywhere in North America.

If you have any questions about the use or effect of this document, you should seek the advice of a lawyer who

can advise you about the validity and the consequences of using this document.

July 2015

REVOCATI O N O F P O WE R O F ATTORNE Y

For Student Ai d Alberta

This REVOCA TION OF POWER OF ATTORNEY is given by me, _______________________________

(Full l egal name of the student, the “Donor”)

of___________________________________________________________________________________

(Address)

1. Revocation: I revoke the Power of Attorney for Student Aid Alberta pr eviously giv en by me on t he

_____ ___________ day of ________ _________ __________________ ___, 20________, appoint ing

(day) (month) (year)

_______________________________________________of_________________________________

(Full l egal nam e of the attorney, the “Attorney”) (Address)

as my lawful attorney to do anything on my behalf that I may law f ully do by an attor ney in respect of all

student l oans , gr ants and other fi nancial assistance made available to me for educational pur poses by

Her Ma jesty the Queen in r ight of Al berta as repr esented by the Minister of Innovation and Advanced

Education (“Student Aid Albert a”), but which excluded the sig nin g and submiss ion o f any Application

for Student Financ ial Assistance t o St udent Aid Alberta and also excluded the signing and submission

of any Mast er St udent Financial Assistance Agreement – Alberta.

2. Representatio ns a nd Warranties: I repr esent and warrant to Student Aid Alberta that I have the

mental c apacity to under stand the nature and effect of this Revoc ation of P ower of Attorney.

3. Indemnity: I indemni fy and hold harmless Student Aid Al ber t a, and its directors, officers, employees

and agent s, against any and all cl ai m s , losses, liabili t ies and expenses (includi ng legal costs on a

solicitor and client basis) t hat St udent Aid Alber t a incurs in a ny way relating t o it s actions under, or in

relianc e upon, this Revocation of Power of At t or ney.

This document has been signed and delivered by the Donor ( St udent) named in t his Revocation of

Power o f Att or ney in the presence of two Witnesse s:

________________________________________ _____ Dated the _____ day of ___ _________, 20 ____.

Signature of Donor (Student) revoking the Power of Attorney

Sign ed by two Witne sse s in the presence of the Donor (Student):

(For Witnessing Requirements, see “Who is the ‘Witness’?” on the instruction sheet attac hed to this form)

By signing below, each Witness confirms that they are eligible witnesses as described in the attached

instruction sheet.

__________________________________________ Dated the _______ day of _______________, 20______.

Signature of First Witness

_____________________________________________________________________________________

Print full legal nam e and address of First Witness

__________________________________________ Dated the _______ day of _______________, 20______.

Signature of Second Witness

_________________________________________________________________________________________

Print full legal nam e and address of Second Witness

This Revocation of Pow er of At t or ney has been pr epared for y our convenience and t he G overnment o f

Alberta makes no repre s entation whatsoever about the form, usa bility, or valid ity of this Revocat io n of

Power o f Att or ney. For gener al questions wit h res pect to submiss io n of t his document, c ont act the Stude nt

Aid Albert a Service Centre toll free at 1-855-606-2096 from a nywhere in North America.

If you have any question s about the use or effe ct of this document, you should seek the a dvice of a lawyer

who can adv ise you about the validity and the consequences of using this docum ent .