我/我们_____________________________，是_______国的公民/，根据《中华人民共和国知识产权海关保护条例》，兹委托____________________________________________________（地址：________________________________________________________）代理__________________________（授权号：__________）的知识产权海关保护事宜。

　　Pursuant to relevant provisions of “Regulations of the People‘s Republic of China Governing Customs Protection of Intellectual Property Rights”， I / We， _________________________________， 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：               _____________________________