Customer: gender:

ID number:

Authorized Person: Gender:

ID number:

I am too busy at work to go through the relevant formalities of XXX in person, so I hereby entrust _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Term of entrustment: from the date of signature to the date of completion of the above matters.

Customer:

date month year