How should I write a power of attorney when submitting a notification for National Health Insurance?

Please fill in the details of the procedure, the date of delegation, the name and address of the delegator and the mandator, and affix your seal.
You can also use the proxy appointment form that can be downloaded from the page below.

Note: At the time of notification, it is necessary to verify the identity of the mandated person, so please bring identification documents (driver's license, passport, My Number card, etc.)