藥監(jiān)局授權(quán)委托書格式

1、授權(quán)委托書我公司奧林巴斯（北京）銷售服務(wù)有限公司成都分公司茲委托四川歐依洛醫(yī)療器械有限公司在南充市藥品監(jiān)督管理局醫(yī)療器械處（分局）辦理內(nèi)窺鏡攝像系統(tǒng)、電切鏡附件、電外科手術(shù)器械、超聲內(nèi)窺鏡專用水囊和水囊外鞘管、氣腹機(jī)第二類醫(yī)療器械經(jīng)營每案憑證的相關(guān)事宜。奧林巴斯（北京）銷售服務(wù)有限公司成都分公司2015年05月21日授權(quán)書茲授權(quán)鄧衛(wèi)兵身份證號(hào)36054為我公司代表,負(fù)責(zé)關(guān)于辦理內(nèi)窺鏡攝像系統(tǒng)、電切鏡附件、電外科手術(shù)器械、超聲內(nèi)窺鏡專用水蠹和水囊外鞘管、氣腹機(jī)經(jīng)營許可的相關(guān)事宜，請(qǐng)予以聯(lián)系。授權(quán)公司：四川歐依洛醫(yī)療器械有限公司法定代表人簽字：被授權(quán)人簽字：日期：2015年05月21日授權(quán)委托書埴

2、表說明一、申請(qǐng)單位到市藥品監(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)委托書到市藥品監(jiān)督局受理大廳辦理相關(guān)事宜。二、“委托人”，填寫法定代表人或負(fù)責(zé)人姓名?！氨晃腥恕?，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、“茲委托一在北京市藥品監(jiān)督管理局處（分局）辦理®事宜?！保禾顚懕晃腥诵彰?。：按照申辦事宜內(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。：填寫具體辦事內(nèi)容，如“藥品經(jīng)營許可，4、“授權(quán)范圍”，按照具體授權(quán)

3、情形，已授權(quán)的在“口”中打“M”，未授權(quán)的在“口”中打“X”?！昂炇张臋?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、副本工五、（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”六、在辦理藥品注冊(cè)事項(xiàng)時(shí)，如委托人為二人以上的，須別離列明委托人有關(guān)情形，并在對(duì)應(yīng)位置，別離簽字、加蓋公章。zKAuthorization(Administrative：licenseitems)Consignor:Workunit：Duty：Phonenumber：Consignee:Workunit：Duty：Phonenumber:Atpresent

4、consigntotransactmattersconcernedatthedepartment(substation),BeijingDrugAdministration(BDA).Scopeo£authority:口一Beentitledtoaccepttheexecutivenotificationpursuanttolaw.口二、Beentitledtosubmitcorrect、redress、reinforceapplicationmaterialsonconsignor'sbehalf.3、Beentitledtostateanddefendintheadmin

5、istrativelicensecensoringonconsignor'sbehalf.4、Beentitledtosign&acceptauthorizeddocumcnt(s)like5、Anyothercntitlcmcnt(s)Termofconsignation:Consignee:(theofficialsealofconsignortsworkunit)Amiotarioii:mark"M"inthebeforetheconsignedauthority,otherwise,mark"X”.Authorization(Adminis

6、trativelicenseitems)Consignor：XxLiWorkunit：Co.xxDuty：GeneralmanagerPhonenumber:Consignee:XxLuoWorkunit：Co.xxDuty：BusinesspersonnelPhonenumber:Atpresentconsign_xxLuo_totransactalteringlegalrupresuntativuofMedicalDevicesDistributionEnterpriseLicensermattersconccmcdaFtheAcceptingdepartment_(substation)

7、,BeijingDrugAdministration(BDA).Scopeofauthority:Q*_Beentitledtoaccepttheexecutivenotificationpursuanttolaw.Beentitledtosubmit、correct、redressnreinforceapplicationmaterialsonconsignor'sbehalf.Beentitledtostateanddefendintheadministrativelicensecensoringonconsignorsbehalf.Beentitledtosigil&ac

8、ceptauthorizeddocumcnt(s)like:originalandduplicateofMedicalDepeesDistributionEnterpriseLicense.xAnyotherentitlcmcnt(s).Termofconsignation:January2(),2005-January22,2()05/Cdtisignee:XxLuo|(thcofficialsealofconsign>rrJworkunit)anuary20,2(/January 20,2005、一,Annotation：mark"M"inthebeforethe

9、consignedauthority,otherwise,mark“XInstructiontofillintheAuthorisation一、Iftheapplicaiit/tninsactorisn'tthelegalrepresentativeorisn，ttheprincipal,hc/shcmusthavetheAuthorizauonconsignedbytheIcgiilrepresentative/theprincipalqualifyingtheconsignee'sauthorittoapplyadministrativelicensesmattersinB

10、eijingDrugAdministrati()n(Br)A)TheapplicanttransactsrelevantmattersintheAcceptingHallofBDA,withtheAuthorizudonyifncccssan,.二、Fillinthenameofthelegalrepresentativeortheprincipalinthe“consignor"item;Fillinthenameofthetransactorinthe“consignex"item.Fillinthefallowingitemsbytheveryfact.3、Atpre

11、sentconsign©totransactmattursconcernedatthedcpartmciit(substation),BeijingDrugAdministrati()n(Br>A).：thenameoftheconsignee.：concretematterstobehandlud,suchasdrugsupplylicense.®：thecorrespondingresponsibledepartment,suchasaAcceptanceDepartment"、“DrugRegistrationDepartment"、&quo

12、t;DrugSafetyandInspectionDepartment"、“MedicalDevicesDepartment*etc.4uScopeofauthority"，accordingtoexactauthorizedsituation,mark"M"inthe“匚”bcf()rcauthorizeditemsandmark"X"ifunauthorized.“Buentitledtosign&acceptauthorizedd(x:umcnt(s)like,fillinthenameoftheccrtificatc(s)nauthorizeddocumcnt(s)aiid/orrelevantmatcrial(s)abovetheunderline,suchas“original、duplicateoftheDnigMufactiiringCertiHcte9.五、(theofficialsealofconsignor,sworkunit):toaffixtheofficialsealofconsignorsworkunitConsignee:usignedbythepers