I (we), the undersigned, name(s) of prospective adoption parent(s), US Citizen(s); DOB February 3, 1955; US Passport No. 11111111 issued on March 1, 2001 by National Passport Agency; residing at specify address, phone: (111) 111-1111, fax: (111) 111-1111, with this Power of Attorney do hereby make, constitute and appoint Ivanov Ivan Ivanovich, DOB January 1, 1967, place of birth: Kiev, Ukraine, Citizen of Ukraine, Passport # 1111111 issued on February 1, 2000 by UMVS of Ukraine in Kiev Oblast,

my (our) attorney-in-fact and authorize him to represent me (us) on the territory of Ukraine in all matters related to the adoption of a minor child, and for the above purposes I (we) grant him the following authorities:

(1) to represent me in all agencies, organizations and institutions, regardless of their legal form and type of ownership, as well as in the state authorities, including the National Adoption Center of the Ministry of Education of Ukraine, in tax authorities, statistics agencies, the Ministry of Internal Affairs, any and all ministries, departments and agencies, courts of general jurisdiction, state and arbitral courts, pension and other funds;

(2) to sign for me and to submit on my behalf any and all applications, petitions, complaints and motions, to submit and to receive required certificates and documents including the certificate confirming assignment of a tax identification number;

(3) to represent my interests in any and all courts with all rights granted by the Ukrainian law to plaintiff, defendant, third party and injured party, including the right of full and partial rejection of claims, recognition of claims, conclusion of amicable settlements, appeal of judicial decisions, and to perform other acts and actions necessary for and incident to this Power of attorney;

(4) to conduct negotiations, to negotiate terms and conditions, to sign for me any and all certificates, documents, agreements, necessary for and incident to this Power of attorney.

I hereby approve all acts and actions performed by the above Attorney-in-fact of the basis of this Power of Attorney.

This Power of Attorney may be delegated to third parties.