我/我们是_____的公民/法人，根据中华人民共和国专利法第19条的规定，兹委托_____ (机构代码：__________)，并由该机构指定其专利代理人_____、_____代为办理名称为_______________申请号(或专利号)/国际申请号为_____的专利申请在中华人民共和国的全部专利事宜。
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.
委托人姓名或名称
authorized by (name)
_________
委托人签字或盖章
signature or seal
__________
被委托专利代理机构盖章
seal of the authorized agent
__________
委托日期
date of authorization
__________