Il/La sottoscritto/a ____________填自己姓名____________________________________________________
nato/a ______________________出生地点___________________________ il __出生日子_____________________
residente in via ___________________地址_________________________________ CAP ___邮政编号_______
città ___________________________________城市__________________________ Prov. ____省_____
DELEGA 委托
il/la sig./sig.ra _____________委托人名字______________________________________________________
nato/a _________________出生地点________________________________ il ___出生日子____________________
residente in via _________________地址___________________________________ CAP __邮政编号________
città _________________________________城市____________________________ Prov. ____省_____
a: (indicare il tipo di operazione per cui si effettua la delega) ______________________________________
_______________________________________________________________________________
____________________________________________这里写委托的事___________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Il delegante
__________________________ ______________________________
(luogo e data) (firma)