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1. Hi, what is your name? (insert full name)

2. Where are you living now? (insert complete address)

3. What matter(s) do you need to grant authorization to act on your behalf?

4. Who are you authorizing to act on your behalf?

5. What actions/responsibilities do you authorize this person to take on your behalf?

6. When does this authorization take effect?

7. Who is the recipient of this authorization letter? (Insert full name)

8. What is the recipient's address? (or company name)

9. What is your contact information to get in touch? (email/phone no.)

10. What is today's date?