Free authorization letter template
An authorization letter format for the Philippines to let a representative claim a document, ID or parcel on your behalf, with both valid IDs and a specimen signature. Sample letter for claiming a PSA birth certificate included.
What's in this template
Authorization letter
28 October 2026
The Officer-in-Charge
Philippine Statistics Authority, Civil Registration Service Outlet
SM City North EDSA, Barangay Santo Cristo, Quezon City 1105
Dear Sir or Madam:
I, Maria Lourdes C. Bautista, of legal age, Filipino, married, and residing at 23 Mahogany Street, Barangay Marikina Heights, Marikina City 1810, hereby authorize Mr. Ramon D. Bautista Jr., my brother, of legal age, Filipino, and residing at 112 Ilang-Ilang Street, Barangay Sauyo, Quezon City 1116, to claim on my behalf the following:
| Item | Reference |
|---|---|
| PSA birth certificate (2 copies) in my name | Online request no. PSA-SB-2026-1045872 |
| Date of request | 21 October 2026 |
| Amount paid | ₱465.00, GCash reference 6014 552 908 |
I am unable to claim the documents personally because I am working on a shift schedule in Clark, Pampanga from 26 October to 7 November 2026.
For verification, here are our valid IDs. Photocopies of both IDs, each signed three times, are attached to this letter.
| Name | Valid ID | ID number | Valid until | |
|---|---|---|---|---|
| Owner | Maria Lourdes C. Bautista | Philippine Identification Card (PhilSys) | 4815-2739-0614-8852 | No expiry |
| Representative | Ramon D. Bautista Jr. | Driver's license | N02-14-118462 | 9 May 2029 |
This authorization is valid only from 29 October 2026 to 14 November 2026 and only for the item listed above.
Thank you for your kind assistance.
Respectfully yours,
Maria Lourdes C. Bautista
Signature over printed name
0917 304 6618
Specimen signature of authorized representative
Ramon D. Bautista Jr.
Signature over printed name
0928 711 2045
Attachments:
- Photocopy of the PhilSys ID of Maria Lourdes C. Bautista, signed three times
- Photocopy of the driver's license of Ramon D. Bautista Jr., signed three times
- Printed PSA online request confirmation and GCash receipt
Find it in: Authorization letter sample · Barangay clearance request letter · Special power of attorney (SPA) sample