授權(quán)委托書
(行政審批事項(xiàng))
委托人：
工作單位： 職 務(wù)：
聯(lián)系電話：
被委托人：
工作單位： 職 務(wù)：
聯(lián)系電話：
茲委托 在 辦理
事宜。
授權(quán)范圍：□1、接受行政機(jī)關(guān)依法告知的權(quán)利。
□2、代為提交申請(qǐng)材料、更正、補(bǔ)正、補(bǔ)充材料的權(quán)利。
□3、代理申請(qǐng)人行政許可審查中的陳述和申辯的權(quán)利。
□4、簽收 批件的權(quán)利。
□5、其他權(quán)利 。
委托期限自 年 月 日至 年 月 日。
(委托人單位公章) 被委托人：
年 月 日 年 月 日
注：已授權(quán)的請(qǐng)?jiān)?/span>□中打“√”，未授權(quán)的請(qǐng)?jiān)凇踔写?ldquo;×”。
《授權(quán)委托書》填表說明
1、申請(qǐng)單位到市食品藥品監(jiān)督局辦理行政許可事項(xiàng)時(shí)，申請(qǐng)人不是法定代表人或負(fù)責(zé)人時(shí)，須由法定代表人或負(fù)責(zé)人開具《授權(quán)委托書》給申請(qǐng)人，列明授權(quán)范圍和委托期限。
申請(qǐng)人憑《授權(quán)委托書》到市食品藥品監(jiān)督局受理大廳辦理相關(guān)事宜。
2、“委托人”，填寫法定代表人或負(fù)責(zé)人姓名。
“被委托人”，填寫具體辦事人員姓名。
“工作單位”、“職務(wù)”、“聯(lián)系電話”，據(jù)實(shí)填寫。
3、“茲委托 ① 在北京市食品藥品監(jiān)督管理局 ② 處（分局）辦理
③ 事宜。”
①：填寫被委托人姓名。
②：根據(jù)申辦事宜內(nèi)容填寫對(duì)應(yīng)的主管處室名稱，如“受理辦”、“藥品注冊(cè)處”、“安全監(jiān)管處”、“醫(yī)療器械處”等。
③：填寫具體辦事內(nèi)容，如“藥品經(jīng)營許可”。
4、“授權(quán)范圍”，根據(jù)具體授權(quán)情況，已授權(quán)的在“□”中打“√”，未授權(quán)的在“□”中打“×”。
“簽收 批件的權(quán)利”，在橫線上填寫需領(lǐng)取的證件、批件或有關(guān)材料名稱，如“《藥品生產(chǎn)許可證》正本、副本”。
5、(委托人單位公章)：“加蓋委托人所在單位的公章”
被委托人：“由具體辦事人員簽字”
6、在辦理藥品注冊(cè)事項(xiàng)時(shí)，如委托人為二人以上的，須分別列明委托人有關(guān)情況，并在對(duì)應(yīng)位置，分別簽字、加蓋公章。
示 范
Authorization
（Administrative license items）
Consignor：
Work unit： Duty：
Phone number：
Consignee:
Work unit： Duty：
Phone number：
At present consign _______ ______ to transact ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ matters concerned at the ______ ______ department (substation), Beijing Drug Administration (BDA).
Scope of authority:
□1、Be entitled to accept the executive notification pursuant to law.
□2、Be entitled to submit、 correct 、redress、 reinforce application materials on consignor’s behalf.
□3、Be entitled to state and defend in the administrative license censoring on consignor’s behalf.
□4、Be entitled to sign & accept authorized document(s) like ______ _____ ______ ______ ______ ______ ______ ______ _______ ________.
□5 、Any other entitlement(s) _______ _______ _______ _______ _______.
Term of consignation:
Consignee:
(the official seal of consignor’s work unit)
Annotation: mark“√” in the □ before the consigned authority, otherwise, mark “×”.
Authorization
（Administrative license items）
Consignor：Xx Li
Work unit：Co. xx Duty：General manager
Phone number：
Consignee: Xx Luo
Work unit：Co. xx Duty：Business personnel
Phone number：
At present consign _ xx Luo_ to transact altering legal representative of Medical Devices Distribution Enterprise License matters concerned at the Accepting department (substation), Beijing Food and Drug Administration (BDA).
Scope of authority:
□1、Be entitled to accept the executive notification pursuant to law.
□2、Be entitled to submit、 correct 、redress、 reinforce application materials on consignor’s behalf.
□3、Be entitled to state and defend in the administrative license censoring on consignor’s behalf..
□4、Be entitled to sign & accept authorized document(s) like: original and duplicate of Medical Devices Distribution Enterprise License.
□5、Any other entitlement(s) .
Term of consignation: January 20,2005 - January 22 , 2005
Consignee: Xx Luo
(the official seal of consignor’s work unit)
January 20 , 2005 January 20 , 2005
Annotation: mark“√” in the □ before the consigned authority, otherwise, mark “×”.
Instruction to fill in the Authorization
1、If the applicant/transactor isn’t the legal representative or isn’t the principal, he/she must have the Authorization consigned by the legal representative/the principal qualifying the consignee’s authority, to apply administrative licenses matters in Beijing Drug Administration(BDA)
The applicant transacts relevant matters in the Accepting Hall of BDA, with the Authorization, if necessary.
2、Fill in the name of the legal representative or the principal in the “consignor” item;
Fill in the name of the transactor in the “consignee” item.
Fill in the following items by the very fact.
3、At present consign ______①______ to transact ____②_matters concerned at the ③___department( substation), Beijing Food and Drug Administration(BDA).
①: the name of the consignee.
②: concrete matters to be handled, such as “drug supply license”.
③: the corresponding responsible department, such as “Acceptance Department”、“Drug Registration Department”、“Drug Safety and Inspection Department”、“Medical Devices Department”etc.
4、“Scope of authority”, according to exact authorized situation, mark “√” in the “□” before authorized items and mark “×” if unauthorized.
“Be entitled to sign & accept authorized document(s) like ______”, fill in the name of the certificate(s)、authorized document(s) and/or relevant material(s) above the underline, such as“original、duplicate of the Drug Manufacturing Certificate”.
5、(the official seal of consignor’s work unit): “to affix the official seal of consignor’s work unit”
Consignee:“signed by the personnel who hand affairs practically (contractor)”
6、While handling drug registration items, if the consigners outnumber 2, they must list their individual information respectively and sign and affix their official seals where needed.