[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]

[Recipient’s Name]
[Recipient’s Position]
[Organization’s Name]
[Organization’s Address]
[City, State, ZIP Code]

Subject: Authorization for Information Release

Dear [Recipient’s Name],

I, [Your Name], residing at [Your Address], hereby authorize [Authorized Person’s Name], residing at [Authorized Person’s Address], to access and obtain the following information on my behalf from [Organization’s Name]:

  1. [Specific Information 1]
  2. [Specific Information 2]
  3. [Specific Information 3]

This authorization is effective from [start date] to [end date] and includes the authority to sign any required documents or forms related to the release of information. The purpose of this authorization is to facilitate the efficient handling of my affairs during my absence due to [reason, e.g., travel, work commitments, health issues].

Attached are copies of my identification and [Authorized Person’s Name]’s identification for verification purposes. Should you require any further information or have any questions, please contact me directly at [your phone number] or [your email address].

Thank you for your cooperation.

Sincerely,
[Your Name]
[Signature]
[Witness’s Name]
[Witness’s Address]
[Witness’s Signature]