我/我們是_____的公民/法人，根據中華人民共和國專利法第19條的.規定，茲委託_____ (機構程式碼：__________)，並由該機構指定其專利代理人_____、_____代為辦理名稱為_______________申請號(或專利號)/國際申請號為_____的專利申請在中華人民共和國的全部專利事宜。
Pursuant to the Article 19 of the Patent Law of the People’s Republic of China, I/we, citizen/legal entity of_____hereby authorize _____ (Code:_____) to appoint its patent attorney(s)_____ ，_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the PRC.
委託人姓名或名稱
Authorized by (Name)
_________
委託人簽字或蓋章
Signature or Seal
__________
被委託專利代理機構蓋章
Seal of the Authorized Agent
__________
委託日期
Date of Authorization
__________