A specimen Power of Attorney/Letter of Authorisation for an administrative procedure purposes
POWER OF ATTORNEY/LETTER OF AUTHORISATION
…………………………… (name, address, identification number and other identifying data of a principal i.e. a person who issues the power of attorney – which can be a marketing authorisation holder/applicant for a marketing authorisation of a veterinary medicinal product, variation to the marketing authorisation, transfer of the marketing authorisation etc) (hereinafter referred to as the “principal”)
hereby appoints
…………………………….. (an agent – attorney in-fact and that can be::
a) either a LEGAL PERSON – i.e. a company – name, full address, identification number and other identifying data
b) or a NATURAL PERSON – i.e. Mr/Ms – full name of an agent, place of residence(full address), other identifying data eventually)
(hereinafter referred to as the “agent“)
to act as our Agent/Attorney ……………………………………
Specify kind and scope of actions for which the agent is empowered e.g.
· in all actions carried out within all marketing authorisation procedures of veterinary medicinal products, an existing marketing authorisation holder of which is a company ……………………. (insert a company name, address, identification number and other identifying data)
· in all actions that will be carried out in relation to all applications for the marketing authorisation of veterinary medicinal products in relation with future applications submitted by a company ………………………(insert a company name, address, identification number and other identifying data)
· in all actions performed within a marketing authorisation procedure of a medicinal product XY
· to represent in all matters in relation with administrative actions within the mutual recognition procedure kept under the procedure number ………or for a medicinal product XY
This Power of Attorney is valid for a definite period of time/for an indefinite period of time. (Choose one option, if the power of attorney is valid for a definite period of time please specify an expiry date of the power of attorney. 5 years period for the power of attorney validity is recommended).
The principal commits oneself to notify immediately the Institute for State Control of Veterinary Biologicals and Medicinal Products of all new matters which could vary this power of attorney e.g. a termination of a co-operation between a principal and a agent.
In ……. date … (issue date of the power of attorney)
…………………………..
Name and surname of the principal + signature
(The signature should be notarised and the power of attorney should be undersigned by a person who is eligible to act on behalf of the principal, e.g. a company agent, holder of procuration, corporate director etc.)
Furthermore a statement of the agent that he/she accepts the power of attorney can be included (optional) e.g.:
I accept this Power of Attorney.
…………………………..
Date and signature of the agent
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