____________________, citizen / legal entity of _____________, hereby authorize _____________________________ ( Address: ___________________________________) to represent me / us in Customs recordation and protection matters on intellectual property for my / our IPR _____________________________________ under registration certificate No. _________.
委托单位名称或委托人姓名：
Authorized by (Print or Type Name): _____________________________
委托单位印章或委托人签字：
Seal or Signature: _____________________________
委托日期：
Date of Authorization: _____________________________
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