Agreement to End an Appointment of Agent - AUQLDREPS065

Additions / Changes:

Item 1

CLIENT

Name/s: …………………………………….…………………………………………………………………….……

Address: ……………………………………………..………………………………………………………………...

Phone:………..……………............   Fax: ..………………..................  Mobile: …………………...............

Email:  …………………………………………….....……………………....……………………………...............

Item 2

AGENT

Name/s: …………………………………….…………………………………………………………………….……

Address: ……………………………………………..………………………………………………………………...

Phone:………..……………............   Fax: ..………………..................  Mobile: …………………...............

Email:  …………………………………………….....……………………....……………………………...............

Clause 4

By signing this Agreement all parties agree to having given prior approval, in accordance with the Electronic Transactions (Queensland) Act 2001, for electronic transmission of this Agreement and any other related agreements, for signing purposes or otherwise, by such means of communication as have been indicated in the Item Schedule to this document (ie. Facsimile numbers & email addresses).

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