02.12.2000 (Date)

5th street,main road ,Netherland(your address)

We ______ (identify yourself) hereby authorize ____________ (Name of the authorized) to act on our behalf to ___________ (explain duties or responsibilities) any acts carried out by _______________ (name of authorized person) on our behalf will have the same impact as if it our own work done.

This authorization is valid until further written notice from ______ (organization name) decides to end the authorization. Enclosed are _______ (state any important document attached)

Thank you.

Sincerely,
Angeline
Full Name: