药监局授权委托书格式

1、授权委托书我公司奥林巴斯（北京）销售服务有限公司成都分公司兹委托四川欧依洛医疗器械有限公司在南充市药品监督管理局医疗器械处（分局）办理内窥镜摄像系统、电切镜附件、电外科手术器械、超声内窥镜专用水囊和水囊外鞘管、气腹机第二类医疗器械经营每案凭证的相关事宜。奥林巴斯（北京）销售服务有限公司成都分公司2015年05月21日授权书兹授权邓卫兵身份证号36054为我公司代表,负责关于办理内窥镜摄像系统、电切镜附件、电外科手术器械、超声内窥镜专用水蠹和水囊外鞘管、气腹机经营许可的相关事宜，请予以联系。授权公司：四川欧依洛医疗器械有限公司法定代表人签字：被授权人签字：日期：2015年05月21日授权委托书埴表说明一、申请单位到市药品监督局办理行政许可事项时，申请人不是法定代表人或负责人时，须由法定代表人或负责人开具授权委托书给申请人，列明授权范围和委托期限。申请人凭授权委托书到市药品监督局受理大厅办理相关事宜。二、“委托人”，填写法定代表人或负责人姓名。“被委托人”，填写具体办事人员姓名。“工作单位”、“职务”、“联系电话”，据实填写。3、“兹委托一在北京市药品监督管理局处（分局）办理事宜。”：填写

2、被委托人姓名。：按照申办事宜内容填写对应的主管处室名称，如“受理办”、“药品注册处”、“安全监管处”、“医疗器械处”等。：填写具体办事内容，如“药品经营许可，4、“授权范围”，按照具体授权情形，已授权的在“口”中打“M”，未授权的在“口”中打“X”。“签收批件的权利”，在横线上填写需领取的证件、批件或有关材料名称，如“药品生产许可证正本、副本工五、（委托人单位公章）：“加盖委托人所在单位的公章”被委托人：“由具体办事人员签字”六、在办理药品注册事项时，如委托人为二人以上的，须别离列明委托人有关情形，并在对应位置，别离签字、加盖公章。zKAuthorization(Administrative：licenseitems)Consignor:Workunit：Duty：Phonenumber：Consignee:Workunit：Duty：Phonenumber:Atpresentconsigntotransactmattersconcernedatthedepartment(substation),BeijingDrugAdministration(BDA).Scopeoauthorit

3、y:口一Beentitledtoaccepttheexecutivenotificationpursuanttolaw.口二、Beentitledtosubmitcorrect、redress、reinforceapplicationmaterialsonconsignorsbehalf.3、Beentitledtostateanddefendintheadministrativelicensecensoringonconsignorsbehalf.4、Beentitledtosign&acceptauthorizeddocumcnt(s)like5、Anyothercntitlcmcnt(s)Termofconsignation:Consignee:(theofficialsealofconsignortsworkunit)Amiotarioii:markMinthebeforetheconsignedauthority,otherwise,markX”.Authorization(Administrativelicenseitems)Consignor：XxLiWorkunit：C

4、o.xxDuty：GeneralmanagerPhonenumber:Consignee:XxLuoWorkunit：Co.xxDuty：BusinesspersonnelPhonenumber:Atpresentconsign_xxLuo_totransactalteringlegalrupresuntativuofMedicalDevicesDistributionEnterpriseLicensermattersconccmcdaFtheAcceptingdepartment_(substation),BeijingDrugAdministration(BDA).Scopeofauthority:Q*_Beentitledtoaccepttheexecutivenotificationpursuanttolaw.Beentitledtosubmit、correct、redressnreinforceapplicationmaterialsonconsignorsbehalf.Beentitledtostateanddefendintheadministrativelicensec

5、ensoringonconsignorsbehalf.Beentitledtosigil&acceptauthorizeddocumcnt(s)like:originalandduplicateofMedicalDepeesDistributionEnterpriseLicense.xAnyotherentitlcmcnt(s).Termofconsignation:January2(),2005-January22,2()05/Cdtisignee:XxLuo|(thcofficialsealofconsignrrJworkunit)anuary20,2(/January 20,2005、一,Annotation：markMinthebeforetheconsignedauthority,otherwise,mark“XInstructiontofillintheAuthorisation一、Iftheapplicaiit/tninsactorisntthelegalrepresentativeorisn，ttheprincipal,hc/shcmusthavetheAuthoriz

6、auonconsignedbytheIcgiilrepresentative/theprincipalqualifyingtheconsigneesauthorittoapplyadministrativelicensesmattersinBeijingDrugAdministrati()n(Br)A)TheapplicanttransactsrelevantmattersintheAcceptingHallofBDA,withtheAuthorizudonyifncccssan,.二、Fillinthenameofthelegalrepresentativeortheprincipalinthe“consignoritem;Fillinthenameofthetransactorinthe“consignexitem.Fillinthefallowingitemsbytheveryfact.3、Atpresentconsigntotransactmattursconcernedatthedcpartmciit(substation),BeijingDrugAdministrati()

7、n(BrA).：thenameoftheconsignee.：concretematterstobehandlud,suchasdrugsupplylicense.：thecorrespondingresponsibledepartment,suchasaAcceptanceDepartment、“DrugRegistrationDepartment、DrugSafetyandInspectionDepartment、“MedicalDevicesDepartment*etc.4uScopeofauthority，accordingtoexactauthorizedsituation,markMinthe“匚”bcf()rcauthorizeditemsandmarkXifunauthorized.“Buentitledtosign&acceptauthorizedd(x:umcnt(s)like,fillinthenameoftheccrtificatc(s)nauthorizeddocumcnt(s)aiid/orrelevantmatcrial(s)abovetheunderline,suchas“original、duplicateoftheDnigMufactiiringCertiHcte9.五、(theofficialsealofconsignor,sworkunit):toaffixtheofficialsealofconsignorsworkunitConsignee:usignedbythepersonnelwhohandaffairspractically(contractor)六、Whilehandlingdrugregistrationitems,iftheconsignersoutnumber2,theymustlisttheirindividualinformationrespectivelyandsigilandaffixtheirofficialsealswhuruneeded.

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