中英委托書(15篇)

第1篇 專利代理委托書中英版

我/我們是_____的公民/法人，根據(jù)中華人民共和國專利法第19條的規(guī)定，茲委托_____ (機構(gòu)代碼：__________)，并由該機構(gòu)指定其專利代理人_____、_____代為辦理名稱為_______________申請?zhí)?或?qū)＠?/國際申請?zhí)枮開____的專利申請在中華人民共和國的全部專利事宜。

pursuant to the article 19 of the patent law of the people’s republic of china, i/we, citizen/legal entity of_____hereby authorize _____ (code:_____) to appoint its patent attorney(s)_____ ，_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the prc.

委托人姓名或名稱

authorized by (name)

_________

委托人簽字或蓋章

signature or seal

__________

被委托專利代理機構(gòu)蓋章

seal of the authorized agent

__________

委托日期

date of authorization

__________

第2篇 出國委托書中英版

委托他人代表自己行使自己的合法權(quán)益，委托人在行使權(quán)力時需出具委托人的法律文書。在生活工作中很多時候用到委托書，下面小編為大家?guī)沓鰢袝杏娣段模Ｍ麑Υ蠹矣兴鶐椭?/p>

出國委托書

letter of attorney

consigner: hu fang, female, id card no.: trustee: fu zhihua, male, id card no.:

the consignor hu fang and the trustee fu zhihua was registered to marry on sept.7, 19xx. on august 25, 20xx, their son fu pengyuan was born. now, the consignor hu fang entrust her husband fu zhihua being fully responsible for all the affairs regarding their son fu pengyuan during his staying in foreign country from august 2, 20xx to august 19, 20xx.

the period validity of the letter of attorney is from signing the letter of attorney to the son gets back to china.

the trustee has no entrustment transferring right.

consigner: hu fang

june 27, 20xx

譯文：

委托人：胡芳，女，公民身份號碼:

受托人: 付志華，男, 公民身份號碼：

委托人胡芳和受托人付志華于一九xx年九月七日登記結(jié)婚，二0xx年八月二十五日生育一子付鵬遠，現(xiàn)委托人胡芳委托丈夫付志華全權(quán)負責兒子付鵬遠在國外期間的一切事務。

本委托書期限自簽署之日起至回國之日為止。

受托人無轉(zhuǎn)委托權(quán)。

委托人：

二○xx年九月一日

第3篇 中英文專利代理委托書格式范本

我/我們是_____的公民/法人，根據(jù)中華人民共和國專利法第19條的規(guī)定，茲委托_____ (機構(gòu)代碼：__________)，并由該機構(gòu)指定其專利代理人_____、_____代為辦理名稱為_______________申請?zhí)?或?qū)＠?/國際申請?zhí)枮開____的專利申請在中華人民共和國的全部專利事宜。

pursuant to the article 19 of the patent law of the people’s republic of china, i/we, citizen/legal entity of_____hereby authorize _____ (code:_____) to appoint its patent attorney(s)_____ ，_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the prc.

委托人姓名或名稱

authorized by (name)

_________

委托人簽字或蓋章

signature or seal

__________

被委托專利代理機構(gòu)蓋章

seal of the authorized agent

__________

委托日期

date of authorization

__________

第4篇 專利代理委托書中英文版

我/我們是_____的公民/法人，根據(jù)中華人民共和國專利法第19條的規(guī)定，茲委托_____ (機構(gòu)代碼：__________)，并由該機構(gòu)指定其專利代理人_____、_____代為辦理名稱為_______________申請?zhí)?或?qū)＠?/國際申請?zhí)枮開____的專利申請在中華人民共和國的全部專利事宜。

pursuant to the article 19 of the patent law of the people’s republic of china, i/we, citizen/legal entity of_____hereby authorize _____ (code:_____) to appoint its patent attorney(s)_____ ，_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the prc.

委托人姓名或名稱

authorized by (name)

_________

委托人簽字或蓋章

signature or seal

__________

被委托專利代理機構(gòu)蓋章

seal of the authorized agent

__________

委托日期

date of authorization

__________

第5篇 留學法定監(jiān)護人委托書(中英文)

要出國留學最好在國外有監(jiān)護人，下面是由小編為大家?guī)淼年P(guān)于留學法定監(jiān)護人委托書，希望能夠幫到您!

留學法定監(jiān)護人委托書(中英文)

致任何有關(guān)人員：

本人身份證號碼： 及配偶，身份證號碼： 自愿同意我的孩子 護照號碼： 參加 機構(gòu)組織的赴美暑期交流活動，為保障我們的子/女的合法權(quán)益不受侵害，本人特此授權(quán)/女士為我子/女在美期間的臨時法定監(jiān)護人。在臨時監(jiān)護期間，未經(jīng)臨時監(jiān)護人同意，任何人不得以任何理由將我的子/女帶離臨時監(jiān)護人的監(jiān)護范圍(包括本人在美的親屬朋友在內(nèi))同時我們的子女的護照交由臨時監(jiān)護人保管，任何人(包括孩子本人)不得以任何理由向他/她索要。我們的子女將接受臨時監(jiān)護人為保證其健康和人身安全做出的各種要求：如飲食、戶外活動、與陌生人交往等方面。

特此聲明：

父親：日期： 母親：日期：

住址： 電話：

to whom it may concern:

this is to certify that and my are willing to send our join the summer exchange program in the united states sponsored ciation. we hereby entrust the legal guardian of our child during his/her stay in united states. the legal guardian will supervise our child’s activities, keep his/her passport and be responsible for our child’s return to china. no person shall take my child or his/her passport away without written permission of the legal guardian named above.

father: mother:

第6篇 中英文版授權(quán)委托書

the letter of authorization (power of attorney)

i, the undersigned mr. /ms. _____representing ___________(company name), a corporation duly established by and existing under the law of_________(region) and having its office at _________(address), hereby constitute and appoint the below-mentioned persons mr./ms. ______, to represent us with regard to the notifications, communication or demand required or permitted under the general frame cooperation agreement between _________ (company name)and __________(company name).

hereby warrant and certify that the signatory, whose signature appears below are genuine and authentic, has been and is on the date set forth below, duly authorized by all necessary and appropriate action to execute the agreement.

[signatur

e to be authorized] [date]

[print signature in english] [print e-mail address]

[print full title of authorized peron] [print tel number]

[print name of company] [company chop/seal as applicable]

by [signature][date]

[print signature in english] [print e-mail address]

[print full title of executing officer] [print tel number]

[print address]

有權(quán)簽字人委托書

茲全權(quán)委托 x x x 先生（女士）和 x x x 先生（女士）代表本公司與貴公司簽署貨物買賣合同事宜，其代表本公司簽署的合同、訂單以及其他文件，本公司確認其法律效力。以上代理人的簽名樣本如下：

x x x x x x（簽字樣本）

x x x x x x（簽字樣本）

以上代理人的簽字在本公司送達貴公司有關(guān)變更通知以前，本公司確認其法律效力。

x x x x 有限公司董事長：x x x（簽字）（公司印章）200x年x月x日

英文版授權(quán)委托書

委 托 書

i, _____________________(name), passport/identity card

本 人, (姓名) 護 照/ 身 份 證 號 碼

茲 委 托(姓名)

護 照/身 份 證 號 碼

代 表 我 遞 交/ 領(lǐng) 取

my visa application

我 的 簽 證 申 請。

on my behalf.

_______________________________

signature of applicant date

申 請 人 簽 名 、加蓋企業(yè)公章 日 期

中英文版授權(quán)委托書

第7篇 一般授權(quán)委托書精選（中英文）

一般授權(quán)委托書

general power of attorney

一般授權(quán)委托書

我，＿＿（姓名），＿＿（地址等），在此指定＿＿（姓名），＿＿（地址或律師事務所名稱等），為我的律師，以我的身份履行一切實踐中我通過律師所能從事的合法行為。本權(quán)利在以下載明日期全權(quán)生效并一直持續(xù)到＿＿或持續(xù)到雙方當事人規(guī)定的延展期或提前撤銷期。

dated＿＿（6）＿＿,20＿（7）＿. ＿＿（8）＿＿

state of＿＿（9）＿＿ （簽名處）

county of＿＿（10）＿＿

日期：＿＿

地址：＿＿

州名和縣名：＿＿

proxy委托書

茲有我，＿＿（姓名），為＿＿（公司名稱及性質(zhì)）的以下署名股東，在此任命和指定＿＿（姓名）為我的事實和合法授權(quán)代理人，為我和以我的名義、職位和身份，在上述公司于＿＿（日期）召開的或就此延期召開的股東大會上作為我的代理人對與會前合法提交大會討論的任何事項進行表決，且為我和以我的名義，在大會上全權(quán)履行我的職責；在此我撤銷此前所作的任何其他授權(quán)委托。

witness my hand a nd seal this＿＿（6）＿＿day of＿＿（7）＿＿,20＿＿（8）＿＿.

于20＿＿年＿＿月＿＿日簽字蓋章，特此為證。

第8篇 最新民事案件授權(quán)委托書（中英文版）

授權(quán)委托書

power of attorney

按照 組建、總部在意大利的aa 公司，現(xiàn)授權(quán)廣東fk律師事務所執(zhí)業(yè)律師meredith lee(執(zhí)業(yè)證號： )代表我公司行使以下權(quán)利：

aa s.p.a.(hereinafter called corporation)， incorporated by the xx code and having its principal executive office in the city of bergamo， italy， hereby appoint and empower attorney meredith lee， who is a certified attorney in guangdong fk law firm， guangdong (license no. xx )， to be my agent ad item. corporation further appoint and empower the above-mentioned attorney to:

1. 根據(jù)案件具體情況，向中國有管轄權(quán)的法院提起民事訴訟。

1. pursuant to the actual situation and bring civil litigations to the people’s courts that have jurisdiction over the lawsuits.

2. 在根據(jù)本授權(quán)書1授權(quán)所提起的訴訟中代表我行使訴訟程序中的全部權(quán)利和義務。特別授權(quán)：在一審、二審程序中行使包括但不限于以下權(quán)利：

2. exercise all the rights and assume all the obligations on my behalf in the litigations that are brought according to the above 1. special agency: to exercise the following rights (including but not limited to) in the first instance and second instance on my behalf，

a)提起訴訟和提出訴訟請求;

a) to bring litigations and lay claims;

b)向法庭提交證據(jù)和其他與訴訟有關(guān)的文件;

b) to deliver evidences and other related documents to the courts;

c)簽署并接收法院發(fā)出的各種文書;

c) to sign and receive legal paper issues by the courts;

d)訴訟各環(huán)節(jié)的出庭;

d) to appear in the court whenever needed in the process of litigation;

e)向有管轄權(quán)的法院申請執(zhí)行已生效的法院判決、裁定、調(diào)解書等法律文書;

e) to apply to the courts that have jurisdiction to enforce the binding judgments， decisions， mediation documents and other legal paper;

f)代表我表達對案件處理的意見，出具對案件處理的意見書。

f) to express the opinions on the result of the cases on my behalf in verbal form as well as in written form;

3. 該授權(quán)書可適用于在授權(quán)有效期內(nèi)發(fā)生的多個訴訟行為，均有授權(quán)的效力。

3. this power of attorney shall be applied to more than one litigations within the term of validity.

4. 在為了授權(quán)人的利益時，被授權(quán)人可以授權(quán)他人行使被授權(quán)人因本授權(quán)書獲得的部分權(quán)利。

4. the above-mentioned attorney may， in the principal’s interests， entrust the others to exercise part of the power entrusted in this power of attorney.

委托期限自授權(quán)委托書簽訂之日起至xx 年8 月30日。

we hereby confirm that this power of attorney shall remain in full force from the date of signature to august 30， xx(m/d/y).

作為證據(jù)，本人于此正式簽訂本授權(quán)委托書。

in witness whereof i cause this power of attorney to be duly signed.

授權(quán)人簽名：

signature：

簽訂日期：

date:

第9篇 個人中英文委托書范本

委托書,是指委托他人代表自己行使自己的合法權(quán)益時所簽訂的法律文書.本章小編給大家?guī)砹藗€人中英文委托書范本，希望對你有所幫助。

個人中英文委托書范本（一）

the letter of authorization (power of attorney)

i, the undersigned mr. /ms. _____representing ___________(company name), a corporation duly established by and existing under the law of_________(region) and having its office at _________(address), hereby constitute and appoint the below-mentioned persons mr./ms. ______, to represent us with regard to the notifications, communication or demand required or permitted under the general frame cooperation agreement between _________ (company name)and __________(company name).

hereby warrant and certify that the signatory, whose signature appears below are genuine and authentic, has been and is on the date set forth below, duly authorized by all necessary and appropriate action to execute the agreement.

[signature to be authorized] [date]

[print signature in english] [print e-mail address]

[print full title of authorized peron] [print tel number]

[print name of company] [company chop/seal as applicable]

by [signature] [date]

[print signature in english] [print e-mail address]

[print full title of executing officer] [print tel number]

[print address]

有權(quán)簽字人委托書

茲全權(quán)委托 x x x 先生（女士）和 x x x 先生（女士）代表本公司與貴公司簽署貨物買賣合同事宜，其代表本公司簽署的合同、訂單以及其他文件，本公司確認其法律效力。以上代理人的簽名樣本如下：

x x x x x x（簽字樣本）

x x x x x x（簽字樣本）

以上代理人的簽字在本公司送達貴公司有關(guān)變更通知以前，本公司確認其法律效力。

x x x x 有限公司 董事長：x x x（簽字）（公司印章） 200x年x月x日

個人中英文委托書范本（二）

i,__(1)__,of__(2)__,hereby appoint__(3)__,of__(4)__,as my attorney in fact to act in my capacity to do every act that i may legally do through an attorney in fact. this power shall be in full force and effect on the date below written and shall remain in full force and effect until__(5)__or unless specifically extended or rescinded earlier by either party.

我，__(姓名)，__(地址等)，在此指定__(姓名)，__(地址或律師事務所名稱等)，為我的律師，以我的身份履行一切實踐中我通過律師所能從事的合法行為。本權(quán)利在以下載明日期全權(quán)生效并一直持續(xù)到__或持續(xù)到雙方當事人規(guī)定的延展期或提前撤銷期

個人中英文委托書范本（三）

dated__(6)__,20_(7)_. __(8)__

state of__(9)__ (簽名處)

county of__(10)__

日期：__

地址：__

州名和縣名：__

proxy委托書

be it dnown, that i,__(1)__,the undersigned shareholder of__(2)__,a__(3)__corporation, hereby constitute and appoint__(4)__as my true and lawful attorney and agent for me and in my name, place and stead, to vote as my proxy at the meeting of the shareholders of the said corporation, to be held on__(5)__or any adjournment thereof, for the transaction of any business which may legally come before the meeting, and for me and in my name, to act as fully as i could do if personally present; and i herewith revoke any other proxy heretofore given.

witness my hand and seal this__(6)__day of__(7)__,20__(8)__

茲有我，__(姓名)，為__(公司名稱及性質(zhì))的以下署名股東，在此任命和指定__(姓名)為我的事實和合法授權(quán)代理人，為我和以我的名義、職位和身份，在上述公司于__(日期)召開的或就此延期召開的股東大會上作為我的代理人對與會前合法提交大會討論的任何事項進行表決，且為我和以我的名義，在大會上全權(quán)履行我的職責;在此我撤銷此前所作的任何其他授權(quán)委托。

第10篇 一般授權(quán)委托書（中英文）

一般授權(quán)委托書范本（中英文）

一般授權(quán)委托書

general power of attorney

一般授權(quán)委托書

我，＿＿（姓名），＿＿（地址等），在此指定＿＿（姓名），＿＿（地址或律師事務所名稱等），為我的律師，以我的身份履行一切實踐中我通過律師所能從事的合法行為。本權(quán)利在以下載明日期全權(quán)生效并一直持續(xù)到＿＿或持續(xù)到雙方當事人規(guī)定的延展期或提前撤銷期。

dated＿＿（6）＿＿,20＿（7）＿. ＿＿（8）＿＿

state of＿＿（9）＿＿ （簽名處）

county of＿＿（10）＿＿

日期：＿＿

地址：＿＿

州名和縣名：＿＿

proxy委托書

茲有我，＿＿（姓名），為＿＿（公司名稱及性質(zhì)）的以下署名股東，在此任命和指定＿＿（姓名）為我的事實和合法授權(quán)代理人，為我和以我的名義、職位和身份，在上述公司于＿＿（日期）召開的或就此延期召開的股東大會上作為我的代理人對與會前合法提交大會討論的任何事項進行表決，且為我和以我的名義，在大會上全權(quán)履行我的職責；在此我撤銷此前所作的任何其他授權(quán)委托。

witness my hand a nd seal this＿＿（6）＿＿day of＿＿（7）＿＿,20＿＿（8）＿＿.

于20＿＿年＿＿月＿＿日簽字蓋章，特此為證。

第11篇 授權(quán)委托書中英文對照

special power of attorney

特 別 授 權(quán) 書

know all men by these presents:

下列為雙方所議定事項：

name of taiwan employer/principal：

臺灣雇主本人/負責人名字（以下簡稱甲方）：

address地址：

name of representative (if applicable)法定代理人(若適用)：

position of representative (if applicable)代理人職稱(若適用)：

do hereby name, constitute and appoint 在此委托、授權(quán)、指派

name of philippine recruitment agency菲律賓招募公司名字（以下簡稱乙方）

golden harvest human resources & management

address地址：suite 406, 4/f, a.p. building, 1563 f. agoncillo st., malate, manila

name of agency representative公司法定代理人：angie y. santiago

position in agency代理人職稱：president

as its true and legal representative to act for and in my name and stead and to perform the following:

為甲方之法定代表人，以甲方之名義執(zhí)行下列事情：

to represent my name before any government and/ or private offices/ agencies in taiwan and the philippines for the purpose of recruiting, hiring and employment of filipino workers;

代表甲方在臺灣及菲律賓兩地，向其政府或私人單位，執(zhí)行菲律賓勞工就業(yè)招募，其招募相關(guān)文件作業(yè)及認證工作；

to recruit filipino workers in my behalf ;

代表甲方進行菲律賓招募程序工作；

to execute, sign, seal, deliver, and present any all documents, and other pertinent papers, instruments and writings of whatever nature, kind and description, including employment contracts, necessary to accomplish the purposes for which this special power of attorney has been granted.

依此授權(quán)書效力作簽署、鑒定、運送所有必要手續(xù)及辦理資料包括勞動契約書以完成招募勞工相關(guān)交易事項。

to bring suit, defend and enter into compromise in my name and stead in litigations and in all matters involving the employment of filipino contract workers, to appear at the pre-trial conferences and hearings of such cases against me; to engage, terminate, substitute and pay for the services of counsel; to submit to voluntary arbitration, to admit facts or documents or enter into stipulation thereof, to conclude amicable settlement or compromise agreement and to file and receive pleadings, affidavits, position papers, motions, memoranda, appeals, petitions orders, decisions, resolutions and other papers in the course of litigation;

若甲方有任何涉及訴訟與抗辯之情事及之前法律程序作業(yè)時，乙方必須代表負責協(xié)調(diào)在勞工就業(yè)契約期限內(nèi)，出席所有有關(guān)甲方之法庭聆訊或庭外和解；乙方必須參與、協(xié)調(diào)、代理及支付相關(guān)咨詢服務費用；以達成和平協(xié)議或妥協(xié)同意書；以接受訴愿書、切結(jié)書、仲裁文件、提議、公告、上訴、請愿、決議、結(jié)論等程序辦理其它有關(guān)訴訟文件；

to assume jointly and solidarity with me any financial or civil liability or obligation that may arise in connection with the recruitment and / or employment of workers for me by virtue of any judgement or awards to such workers, subject to full indemnification and reimbursement by me in for whatever amount it may be forced or obliged to pay in my behalf, including attorney‘s fees and litigation expenses.

甲乙雙方必須于勞工就業(yè)契約期限內(nèi)，共同負擔之任何雇傭關(guān)系所產(chǎn)生任何財務或民事責任，包括因甲方于招募期間與乙方所產(chǎn)生的勞資糾紛、爭議之解決方法，如必要之律師訴訟及服務費用。

hereby granting unto said representative full power and authority to execute or perform whatsoever act, requisite or proper to be done in about the premises as fully to all intents and purposes as i might or could lawfully do if personally present, with power of substitution and revocation and;

特此，甲方授予上述代表人乙方全權(quán)執(zhí)行、準許、確實依法執(zhí)行所代表之一切法律行為。

hereby ratifying and confirming all that said legal representative or substitute shall lawfully do or cause to be done under and by virtue of these presents.

特此，甲方批準及確認其法定代理人乙方之行使本文所述內(nèi)容無誤。

第12篇 中英文付款委托書范本

the letter of authorization (power of attorney)

i, the undersigned mr. /ms. _____representing ___________(company name), a corporation duly established by and existing under the law of_________(region) and having its office at _________(address), hereby constitute and appoint the below-mentioned persons mr./ms. ______, to represent us with regard to the notifications, communication or demand required or permitted under the general frame cooperation agreement between _________ (company name)and __________(company name).

hereby warrant and certify that the signatory, whose signature appears below are genuine and authentic, has been and is on the date set forth below, duly authorized by all necessary and appropriate action to execute the agreement.

[signature to be authorized] [date]

[print signature in english] [print e-mail address]

[print full title of authorized peron] [print tel number]

[print name of company] [company chop/seal as applicable]

by [signature] [date]

[print signature in english] [print e-mail address]

[print full title of executing officer] [print tel number]

[print address]

有權(quán)簽字人委托書

茲全權(quán)委托 x x x 先生（女士）和 x x x 先生（女士）代表本公司與貴公司簽署貨物買賣合同事宜，其代表本公司簽署的合同、訂單以及其他文件，本公司確認其法律效力。以上代理人的簽名樣本如下：

x x x x x x（簽字樣本）

x x x x x x（簽字樣本）

以上代理人的簽字在本公司送達貴公司有關(guān)變更通知以前，本公司確認其法律效力。

第13篇 個人委托書中英文范文

i,___,of____,hereby appoint__(__,of____, as my attorney in fact to act in my capacity to do every act that i may legally do through an attorney in fact. this power shall be in full force and effect on the date below written and shall remain in full force and effect until____or unless specifically extended or rescinded earlier by either party

我，__(姓名)，__(地址等)，在此指定__(姓名)，__(地址或律師事務所名稱等)，為我的律師，以我的身份履行一切實踐中我通過律師所能從事的合法行為。本權(quán)利在以下載明日期全權(quán)生效并一直持續(xù)到__或持續(xù)到雙方當事人規(guī)定的延展期或提前撤銷期。

dated____

日期：__

state of____ (簽名處)

地址：__

county of____

州名和縣名：__

拓展閱讀：委托書格式模板參考

委托人:姓名：_______ 性別:_______ 身份證編號:______________

受托人:姓名：_______ 性別:_______ 身份證編號:______________

委托原因及事項:

因本人工作原因，不能親自到_______辦理_______的相關(guān)手續(xù)，特委托_______作為我的合法代理人全權(quán)代表我辦理相關(guān)事項，對委托人在辦理上述事項過程中所簽署的有關(guān)文件，我均予以認可，承擔相應的法律責任。

委托期限:自簽字之日起至上述事項辦完為止。

委托人有轉(zhuǎn)委托權(quán)。

委托人:_______

受托人:_______

___年___月___日

第14篇 簽證申請代理委托書（中英對照）

authorisation letter

委 托 書

i, _____________________(name), passport/identity card

本 人, ( 姓 名) 護 照/ 身 份 證 號 碼

_____________ , hereby authorised , holder of

茲 委 托 ( 姓 名)

passport/identity card number , to submit/collect

護 照/身 份 證 號 碼 代 表 我 遞 交/ 領(lǐng) 取

my visa application

我 的 簽 證 申 請。

on my behalf.

___________________ ____________

signature of applicant date

申 請 人 簽 名 日 期

第15篇 中英文知識產(chǎn)權(quán)海關(guān)保護授權(quán)委托書范本

我/我們_____________________________，是_______國的公民/法人，根據(jù)《中華人民共和國知識產(chǎn)權(quán)海關(guān)保護條例》，茲委托____________________________________________________（地址：________________________________________________________）代理__________________________（授權(quán)號：__________）的知識產(chǎn)權(quán)海關(guān)保護事宜。

pursuant to relevant provisions of “regulations of the people‘s republic of china governing customs protection of intellectual property rights”， i / we， _________________________________， citizen / legal entity of _____________， hereby authorize _____________________________ （ address： ___________________________________） to represent me / us in customs recordation and protection matters on intellectual property for my / our ipr _____________________________________ under registration certificate no. _________.

委托單位名稱或委托人姓名：

authorized by （print or type name）： _____________________________

委托單位印章或委托人簽字：

seal or signature： _____________________________

委托日期：

date of authorization： _____________________________