Date

AUTHORIZATION

To Whom It May Concern:

This is to authorize the bearer of this letter, ,

my to purchase for me the medicines and goods I need.

I cannot do the purchase personally due to my condition. Please consider the purchase
on my behalf. I have sent also my purchase booklet and my Senior Citizen´s ID card for your
reference.

Sincerely yours,

JOHN A. DOE

Date

AUTHORIZATION

To Whom It May Concern:

This is to authorize the bearer of this letter, ,

my to purchase for me the medicines and goods I need.

I cannot do the purchase personally due to my condition. Please consider the purchase
on my behalf. I have sent also my purchase booklet and my Senior Citizen´s ID card for your
reference.

Sincerely yours,

JOHN A. DOE