Legal

Power of Attorney

Power of attorney for representation in a legal matter

To act on your behalf I need a signed power of attorney. It allows me to request information from, for example, your (former) employer, the Employee Insurance Agency (UWV) or an insurer, to correspond and negotiate with the opposing party, and to represent you in objection and appeal proceedings. You decide which actions you tick. For far-reaching steps, such as signing a settlement agreement, your prior written consent is always required.

Prefer paper?

Download the form, print it and return it signed.

1. Download the power of attorney as a PDF (to print) or as a Word file (to complete digitally).
2. Enter your details, tick the acts you permit and sign under Article 8.
3. Send a scan or clear photo to Roger@rogeriusdiensten.nl, or by post to Bernhardlaan 24, 6133 BK Sittard, the Netherlands.

What does the power of attorney contain?

1. Principal: your details (or those of your company).
2. Attorney-in-fact: Juridisch Adviesbureau Rogerius B.V., Chamber of Commerce (KvK) 88261174.
3. Matter: description of the case and the opposing party.
4. Scope of authority: the acts you permit, to be ticked. Separate, explicit consent for health data.
5. Limitations: settlements, waiver of rights, termination of your employment contract and withdrawal of proceedings only take place with your prior written consent.
6. Duration and termination: valid until the matter is concluded, revocable in writing at any time.
7. Declarations: full information, showing to third parties, processing in accordance with the GDPR, applicability of the general terms and conditions.
8. Signatures by you and, for acceptance, by Rogerius.

Questions about the power of attorney? Feel free to get in touch. How we handle your data is explained in the privacy statement.

← Back to the website