旅居国外退除役人员定期俸金委托 授权书.doc

旅居國外退除役人員定期俸金委託 授權書 (Power of Attorney) 授權人 (Principal) 中文姓名 (Name in Chinese) 英文姓名 (Name in English) 俸金支領 號碼 (Pension Collecting No.) 國民身分證統一編號 (ID No.) 護照號碼 (Passport No.) 國內聯絡人姓名 (Contact Person in Taiwan) 國內聯絡人電話 (Phone Number) (市話): (手機): 國內聯絡人地址 (Address in Taiwan, R.O.C.) 國外地址 (Address Abroad) （請以英文書寫） 國外聯絡電話 (Phone No. Abroad) 授權 事項 (Scope of Authorization) □本人 年 月至 年 月份之退除俸金(含年終慰問金)委託國軍退除役官兵輔導委員會定期撥入原開立之郵局帳戶。 (I authorize the National Rate of Veterans Affairs Council to remit my pension and year-end bonus to my post office account regularly from MM/YY to MM/YY. ) □本人 年 月至 年 月份之退除俸金(含年終慰問金)委託國內親友代領。 ( I authorize the Agent to collect my pension and year–end bonus from MM/YY to MM/YY) 被授權人姓名(Name of the Agent): 身分證號碼(ID No.): 聯絡電話(Phone No.)(市話): 手機(Cell Phone No.): 地址(Address): 授權人與被授權人之關係(Relationship): □其他事項(Others) 授權日期 (Date of Authorization) 中 華 民 國 年 月 日 授權人簽字(Principal Signature): (以下由權責機關填寫/For Authorized Staff Only) I certify that on this day the individual, named (Printed Name of Individual) appeared before me and acknowledged to me that the foregoing document was executed and signed by him/her personally on a free and voluntary basis, and that the document shall be used for the purposes mentioned therein. , (Signature and Seal of Notary Public or Other Competent Authorities) (Date) 備註: 1.本授權書自我國駐外館、處驗證日起一年有效。 (This Power of Attorney