The following form, appointing Rabbi Moss as your agent, must be submitted by Thursday, 25 March 2021 LATEST! DELEGATION OF POWER I, the undersigned, fully empower and permit Rabbi Moss to act in my place and stead, and on my behalf to sell all Chometz possessed by me, knowingly or unknowingly as defined by the Torah and Rabbinic Law (e.g. Chometz, possible Chometz, and all kinds of Chometz mixtures). Also Chometz that tends to harden and adhere to the inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating Chometz and mixtures thereof. This includes all above-mentioned Chometz that will come into my possession from now until Erev Pesach. He is also empowered to lease all places wherein Chometz owned by me may be found particularly at the address/es listed below and elsewhere. Rabbi Moss has full right to appoint any agent or substitute in his stead and said substitute shall have full right to sell and lease as provided herein. He also has the full power and right to act as he deems fit and proper in accordance with all the details of the Bill of Sale used in the transaction to sell all my Chometz, Chometz mixtures, etc., as provided herein. This power is in conformity with all Torah, Rabbinic and Civil laws. Full Name* First Name Last Name Address* Street Address Street Address Line 2 Suburb State Post Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Any other addresses where chometz may be (eg. work, holiday home, etc.) Phone Number* E-mail* It is customary but not mandatory to make a donation when selling the Chometz. If you would like to do so, please use the form below for credit card donations or our bank details for EFT. Nefesh Synagogue Limited 082-309 | 945 177 374 Reference: Pesach donation Payment Credit Card Visa MasterCard American Express Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Expiration Year Amount $18 AUD $36 AUD $54 AUD $72 AUD $180 AUD Submit Should be Empty: This page uses TLS encryption to keep your data secure.