Volkswagen Power Form – Fill Out and Use This PDF

In re: Volkswagen “Clean Diesel” Marketing, Sales, Practices, and Products Liability

Litigation, MDL No. 2672 (N.D. Cal.)

VOLKSWAGEN BUYBACK/LEASE TERMINATION/EMISSIONS MODIFICATION

AUTHORIZATION – LIMITED POWER OF ATTORNEY

The undersigned hereby appoints ___________________________________ to act on

[NAME OF RETURNING PARTY]

_________________________ behalf for the limited purpose of submitting a claim under the

[MY/NAME OF ENTITY’S]

Volkswagen 2.0-liter TDI Class Action Settlement, and completing the buyback transaction, lease termination or emissions modification for _______________________________________,

[MY/NAME OF ENTITY’S]

_______________________________, ______________________ as applicable.

[VEHICLE MAKE, MODEL, AND YEAR]

[INSERT VIN]

This authorization and limited power of attorney takes effect on the date signed, and shall continue until the earlier of the following: (i) the completion of the buyback transaction, lease termination or emissions modification, as applicable, whichever comes first, or (ii) the undersigned terminates it in writing and Volkswagen Group of America, Inc. (“Volkswagen”) receives notice of the revocation. Any termination of this authorization and limited power of attorney pursuant to (ii) above shall not be effective to Volkswagen1 until Volkswagen Group of America, Inc. (“VWGoA”) has actual knowledge of the revocation. This authorization and limited power of attorney shall terminate immediately if _________________________ dies or

[THE UNDERSIGNED]

becomes incapacitated or _________________ ceases to exist.

[NAME OF ENTITY]

The undersigned agrees that VWGoA, Ankura Consulting Group, LLC (the “Claims Supervisor”) and the lawyers appointed by the Court as the Settlement Class Counsel in the Volkswagen “Clean Diesel” litigation may act under this power of attorney. VWGoA, the Claims Supervisor and the Settlement Class Counsel may seek identification of the individual appointed attorney-in-fact and agent under this power of attorney. The undersigned agrees to indemnify and hold harmless Volkswagen for any claims that arise against Volkswagen because of reliance on this power of attorney.

1Volkswagen shall mean Volkswagen AG, Volkswagen Group of America, Inc. (d/b/a Volkswagen of America, Inc. or Audi of America, Inc.), Volkswagen Group of America Chattanooga Operations, LLC, Audi AG, Audi of America, LLC, VW Credit, Inc., VW Credit Leasing, Ltd., Audi Financial Services, VCI Loan Services, LLC, for each of the foregoing, their respective former, present, and future affiliates, parent companies, subsidiaries, predecessors, successors, agents, representatives, administrators, receivers, divisions, dealers, joint ventures, assigns, general partners, limited partners, attorneys, principals, officers, directors, employees, members, contractors, subcontractors and/or suppliers.

In re: Volkswagen “Clean Diesel” Marketing, Sales, Practices, and Products Liability

Litigation, MDL No. 2672 (N.D. Cal.)

Dated:		By (signature):

Name:

[PRINT NAME]2

Name of Entity (if applicable):

[PRINT NAME OF ENTITY]3

Title:

[PRINT BUSINESS TITLE]4

ATTESTATION

The following two witnesses OR Notary Public witnessed the execution of this document.

Witness #1: ________________	Dated: ____________	Signature: _____________
Print Name
Witness #2: ________________	Dated: ____________	Signature: _____________
Print Name

OR

STATE OF ___________, COUNTY OF ____________

BEFORE ME, the undersigned authority, appeared on the Signature Date shown and acknowledged under oath to my satisfaction that he/she has signed, sealed, and delivered this document as his or her act and deed for the purposes therein expressed and in the capacity therein expressed.

Dated:

NOTARY PUBLIC

2Note: If Power of Attorney is for an entity, must match name of individual on Proof of Entity document and Government Issued ID provided.

3Note: If Power of Attorney is for an entity, must match name of entity on Proof of Entity document provided.

4Note: If Power of Attorney is for an entity, must match business title of individual in Proof of Entity document provided.