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This document is used to revoke the authorization of a designated proxy\'s access to a patient\'s MyChart account at Duly Health and Care. It requires the patient to fill in their personal information as well as details about the proxy being revoked.

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How to fill out proxy revocation request

01

Obtain the proxy revocation request form from the relevant authority or website.

02

Fill in your personal details including your name, contact information, and any identification numbers required.

03

Clearly state that you are requesting a revocation of the proxy authorization.

04

Specify the details of the proxy being revoked, including their name and any identification details.

05

Sign and date the form to confirm your request.

06

Submit the completed form to the appropriate office or authority, either physically or electronically as per the instructions.

Who needs proxy revocation request?

01

Individuals who have granted proxy authority to someone else and wish to cancel that authorization.

02

People who have changed their minds about who they want to represent them in specific matters.

03

Anyone who is concerned about the security or appropriateness of a previously appointed proxy.

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What is proxy revocation request?

A proxy revocation request is a formal document submitted by a shareholder to cancel or revoke a previously granted proxy, which is authorization for another individual to vote on their behalf at a shareholder meeting.

Who is required to file proxy revocation request?

Any shareholder who wishes to rescind their previously granted proxy and regain their voting rights at a shareholder meeting is required to file a proxy revocation request.

How to fill out proxy revocation request?

To fill out a proxy revocation request, a shareholder should provide their name, the date of the original proxy, the name of the person to whom the proxy was granted, and any other required identification details. The request should be signed and dated.

What is the purpose of proxy revocation request?

The purpose of a proxy revocation request is to officially cancel any previously granted proxy, thereby ensuring that the shareholder can vote in person or designate a new proxy if desired.

What information must be reported on proxy revocation request?

The information that must be reported includes the shareholder's name, the details of the previously granted proxy (such as the name of the proxy holder and the date of the proxy), and the shareholder's signature verifying the revocation.

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