To:    Manitoba Health c/o Secretary of the MDSTC

Reference:    (drug name, strength and dosage form)

This letter authorizes Manitoba Health to gain access to all information with respect to the product in the possession of Health Canada, the government of any province or territory in Canada, or the Patented Medicine Prices Review Board; and authorizes disclosure of any information with respect to the product in the possession of Manitoba Health to Health Canada, to the government of a province or territory in Canada, to the Canadian Coordinating Office for Health Technology Assessment (CCOHTA), to a Regional Health Authority in Manitoba established under The Regional Health Authority Act or to the Patented Medicine Prices Review Board.

(signature)

(Name and Title of Senior Company Official)

Dear Sir:

I, (Your Name), hereby authorize (Name of Person Authorized) to claim my checkbook and to represent me in my banking transactions with regards to my Bank Account No. #######.

Thank you.

Respectfully yours,

(Your Name and signature of authorizing)

(Name & signature of authorized person)

Date:

Subject: Delivery of letters, articles, subscription magazines

Dear Sir,

I authorize Mr./Ms……………………….. to receive on my behalf all letters registered and unregistered addressed to me.

I therefore request you to deliver letters and other articles to Mr./Ms……………………….., whose signature (……………………………………..(space for signature) is attested by me.

This authorization is valid until further written notice from me.

Thank you,

Yours sincerely,

Signature
Your name
Your Address
Your Contact Number

Date (MM/DD/YYY)

Name of Hospital or Doctor
Street Address
City, State, Zip Code

To Whom It May Concern:

I, (Your Name), hereby authorize (Hospital Name) to release to (Name of Person or Doctor with his qualification), any information in my personal medical records, including all x-rays, CAT scans, and any other information pertinent to my treatment while I am under the care of (Hospital Name) during the time period from (Date of admission till date of discharge). I give my permission for this medical information to be used for the following purpose: to assist in the diagnosis and treatment of my reoccurring abdominal pain. I do not, however, give permission for any other use or for any re-disclosure of this information.

Full name of Patient

Signature of Patient
Date of Signature

DATE:

To whom it may concern:

We the undersigned, hereby authorize ………………………… to act on our behalf in all manners relating to application for equipment authorization, including signing of all documents relating to these matters. Any and all acts carried out by …………………………………. on our behalf shall have the same effect as acts of our own.

This authorization is valid until further written notice from (COMPANY NAME).

Sincerely,

(Company counsel or company officer’s signature)

(Name and Title)

Authorization Letter Template
Authorization letters are needed for authorizing someone on your behalf to carry out your legal, business, medical and other related transactions. For example, a bank may ask you to write an authorization letter for a specific person who will be allowed to receive money from your account. Or you may have to write an authorization letter for releasing your medical records required by a financial institution like an insurance company. There are many other situations where you may be asked to write an authorization letter. Let us enlist some of the situations where you may need to release an authorization letter. You can read more on letter writing.

Situations Requiring Authorization Letters

* Writing the letter to authorize someone to act in your behalf.
* You may want to approve the attendance at a seminar, conference, etc.
* You may authorize a particular medical treatment or legal representation.
* You may want to authorize a particular study or report.
* You may want to grant permission or delegate project or give over responsibility for a particular work.

Authorization Letter Format

An authorization letter is a very important document that helps in granting approval, delegation of responsibility and giving your permission. So it is better if you clearly state what you want and give the exact instructions to avoid any kind of miscommunication or misinterpretation. You need to mention the circumstances and how you wish to dedicate the responsibilities. The letter is supposed to be detailed and specific to help the reader understand what to do, when and what are the ways to carry out your instructions. This will help document the mentioned particulars in order to mitigate liability. The authorization letter format should be similar to a business letter format. It should state all the details of any agreement that you may have entered and do not assume anything that is not written. Also, mention the time frame when the person is allowed to act on your behalf. This is to avoid any kind of misunderstanding and addition of any extra responsibilities without your consent. Let us now have a look at the authorization letter templates.

Federal Authorization
At the federal level, the authorizing official is your parent agency or cabinet-level CIO. To verify the identity of your CIO, refer to www.cio.gov (Note: this link will open a new browser window and leave this site.).

State Authorization
For states and state programs, we will accept authorization from the Office of the Governor or State CIO. To verify the identity of your Governor, refer to www.usa.gov. (Note: this link will open new browser windows and leave this site.)

City Authorization
For cities and townships, we will accept authorization from the mayor (or equivalent official). Letters from the IT official will not be approved.

County Authorization
For counties and parishes, we will accept authorization from county commissioners (or equivalent officials) or the highest-ranking elected county official. Letters from the IT official will not be approved.

U.S. Territory Authorization
For U.S. territories and their cities, we will accept authorization from the territory Chief Information Officer (CIO). To verify the identity of your territory CIO, refer to www.nascio.org. (Note: this link will open a new browser window and leave this site.)

Native Sovereign Nations
The Native Sovereign Nations (NSN) authorizing official is the CIO representative for Indian Affairs.

Letter Templates
Instruct your authorized official to submit a letter authorizing the use of the requested domain name. This letter must be written on agency letterhead and must include the following:

* Statement that the requestor is the highest ranking official
* Domain name requested
* Purpose of the domain
* Statement that the use of the domain is consistent with the requesting organization’s Internet policies
* Name of the Administrative POC who must be a government employee and must be the same as the Administrative POC listed during the domain registration process
* Contact information
* Signature of the authorizing official
* Statement that the requestor will pay the annual domain registration fee prior to the due date

To expedite the processing of your request, use the appropriate letter template below:

*Note: The Administrative POC must be a government employee and must be the same Administrative POC listed for this domain during the registration process. To update this POC in our database, please use the Modify form at https://www.dotgov.gov/account/register_domain.aspx.

* Federal
* State
* City
* County
* U.S. Territories
* Native Sovereign Nations

Letter Submission

Federal, state, city, county, and territory authorization letters should be submitted to the following:
.gov Domain Manager
10304 Eaton Place
Attn: QTDC, 2E08
(.gov Domain Registration)
Fairfax, VA 22030

or

(540) 301-0160(efax)

Native Sovereign Nations authorization letters should be submitted to the following:
Ms. Nita Pitts
Department of the Interior
Bureau of Indian Affairs
Office of the Chief Information Officer
Corporate Oaks Bldg, Room 2548
1849 C. Street NW
Washington, DC 20240-0001

The .gov Domain Manager must receive the authorization letter within 90 days of your registration request. Otherwise, your request may become deactivated and the domain name released for others to use.

In order to have many important errands in life accomplished by others, a professional authorization must be written. Examples such as signing for important documents on a professional level or picking up children from day care on a personal level will definitely require these letters. Many establishments will have their own but some may ask that you draft one for them.

Wording

1. Our example above words this letter professionally ensuring that whoever the reader happens to be will understand that this is strictly business.

2. In our letter, after the opening paragraph and list of items, we’ve remarked that the named person can make decisions for us but we gave a contact number for us in the event unforeseen events arise.

Format

1. Use the Full Block format arrangement for Authorization Letters:

a. to the left margin of the letter header place the return address

b. make two carriage returns

c. directly below the return address, place the date

d. make two carriage returns

e. directly below the date, place the reader’s address

f. make three carriage returns

g. if necessary, include a reference line

h. begin your letter

i. begin each paragraph at the left margin

j. place the closing, signature and typed signature at the left margin.

Tone

1. Ensure your tone is professional and straightforward throughout the letter.

Email

1. With time being as critical to everyone as it is, sending an Authorization Letter via email is now becoming increasingly more accepted.

a. Send your letter in the same format as you would for snail mail – this conveys to the reader that you took the time to create a professional correspondence.

b. Depending on the circumstances, send the message from the appropriate email account: personal email account for a personal correspondence, professional email account for professional correspondence.

Printing

1. Before printing, decide on what paper to use. For Authorization Letters, common bond paper will work.

2. Print your letter and envelope on the same printer using the same font and an envelope that matches the stationery.

Signature

1. Make three carriage returns between the closing and your typed signature. Inside this space, sign your name for professional correspondence. For personal correspondence, there is no need for a typed signature. Simply, sign your name.

To Whom It May Concern:

I hereby authorize the bearer of this letter, Engr. Emerson Navarro of Bataan Heroes Memorial College to act on my behalf in all manners relating to my SSS loan application, including signing of all documents relating to this matter.

Also, I have enclosed my SSS ID and company ID for your further reference.

Thank you.

Sincerely,

(sign)
Merly Soriano

Prudential Life Inc.
Ayala Avenue
Makati City

Dear Sir/Madam:

I, the undersigned, authorized my brother, Rodel Rosario, to claim my payments from your company on my behalf.  He hereby presents at least two (2) cards for identification purposes.

This authorization is applies to all payments dated from July 2008 up to August 2008.  It does not include past August 31, 2008 without my written authorization.

If you have any questions, you may contact me at (047) 791-2911.

Sincerely,

(sign)
Ericson Rosario