委托人________ 身份证号码______________________委托人的联系方式_________________________  

受委托人_______身份证号码___________________________________________________________________

委托事宜：___________________________________________________________________________________

申请查档的事由：____________________________________________________________________________  

                                                                                                                                                                   委托人签名：___________

                                                                                                                                                                                                               日    期：___________