授权委托书 ( 行政审批事项 ) 委托人: 工作单位: 职 务: 联系电话: 被委托人: 工作单位: 职 务: 联系电话: 兹委托 在 办理 事宜。 授权范围:□1、接受行政机关依法告知的权利。 □2、代为提交申请材料、更正、补正、补充材料的权利。 □3、代理申请人行政许可审查中的陈述和申辩的权利。 □4、签收 批件的权利。 □5、其他权利 。 委托期限自 年 月 日至 年 月 日。 ( 委托人单位公章 ) 被委托人: 年 月 日 年 月 日 注:已授权的请在 □中打“√”,未授权的请在□中打“×”。《授权委托书》填表说明 1 、申请单位到市食品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》到市食品药品监督局受理大厅办理相关事宜。 2 、“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 ① 在北京市食品药品监督管理局 ② 处(分局)办理 ③ 事宜。 ” ①:填写被委托人姓名。 ②:根据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 。 ③:填写具体办事内容, 如“药品经营许可” 。 4 、“授权范围”,根据具体授权情况,已授权的在“ □”中打“√”,未授权的在“□”中打“×”。 “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” 。 5 、 ( 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” 6 、在办理药品注册事项时,如委托人为二人以上的,须分别列明委托人有关情况,并在对应位置,分别签字、加盖公章。 示 范 Authorization ( A dministrative license items) Consignor : W ork unit: Duty: P hone number: C onsignee: W ork unit: Duty: P hone number: A t present consign _______ ______ to transact ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ matters concerned at the ______ ______ department (substation), Beijing Drug Administration (BDA). S cope 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 ) A nnotation: mark“√” in the □ before the consigned authority, otherwise, mark “×”. Authorization ( A dministrative license items) Consignor : Xx Li W ork unit: Co. xx Duty: General manager P hone number: C onsignee: Xx Luo W ork unit: Co. xx Duty: Business personnel P hone number: A t 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). S cope 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 A nnotation: 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 A uthorization consigned by the legal representative/the principal qualifying the consignee ’ s authority, to apply administrative licenses matters in Beijing Drug Administration(BDA) T he applicant transacts relevant matters in the Accepting Hall of BDA, with the A uthorization , 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. F ill in the following items by the very fact. 3、 A t 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 “ Accept ance 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.