[ COMPANY LETTERHEAD]

[ DATE ]

[ EMB REGIONAL DIRECTOR’S NAME ]

Regional Director
ENVIRONMENTAL MANAGEMENT BUREAU -
REGION [ NUMBER ]
[EMB REGIONAL OFFICE ADDRESS]  

SUBJECT : AUTHORIZATION

I, the undersigned, __________ with the following ID’s

Gov’t ID # : _____________________ ,
Company ID # : ______________________ ,
Hereby authorize MR/MRS. __________ with the following ID’s
Gov’t ID # :
Company ID #:
to act on my behalf in all manners relating to the application, submission and processing in the EMB
Online services of our Company / Facility Name : ____________ which is located in
_________________. Any and all acts carried out by Mr./Mrs. _____________ on my behalf shall
have the same effect as acts of my own.
Hoping for your kind consideration
Thank you.

[ Signature over Printed Name ]

Senders Name
Contact Number
Photocopy of Senders ID attachment

SENDERS
GOVERNMENT ID SAMPLE

SENDERS
COMPANY ID SAMPLE