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1. Letter Header and Date: Including letterhead (if applicable), date, and reference number
2. Recipient Details: Full name and address of the recipient/organization to whom the authorization is being granted
3. Subject Line: Clear indication that this is an Authorization Release Letter and brief description of its purpose
4. Authorizing Party Details: Full name, address, and any relevant identification numbers of the person/entity giving authorization
5. Authorization Statement: Clear and specific statement of what is being authorized, including the scope and purpose of the authorization
6. Duration of Authorization: Specific timeframe for which the authorization is valid
7. Signature Block: Space for signature, date, and printed name of the authorizing party
1. Witness Details: Required when the authorization needs to be witnessed, including space for witness name, signature, and contact details
2. Revocation Clause: Statement regarding the right to revoke the authorization and the process for doing so
3. Confidentiality Statement: Required when the authorized information is sensitive or confidential
4. Limited Power of Attorney: When the authorization includes decision-making powers
5. Indemnification Clause: When the authorizing party needs to protect the recipient from potential claims
6. Electronic Execution Statement: Required when the letter may be executed electronically
1. Schedule A - Detailed Information List: Itemized list of specific information/documents being authorized for release
2. Schedule B - Authorized Recipients: List of specific individuals or entities authorized to receive the information when multiple recipients are involved
3. Schedule C - Terms and Conditions: Any specific conditions or restrictions on the use of the authorized information
4. Appendix 1 - Identity Verification: Copies of identification documents of the authorizing party when required
Authorized Information
Authorized Period
Authorized Purpose
Authorized Recipients
Confidential Information
Effective Date
Personal Information
Privacy Laws
Recipient Organization
Related Entities
Representatives
Restricted Information
Revocation Notice
Sensitive Information
Third Party Recipients
Healthcare
Financial Services
Education
Legal Services
Real Estate
Insurance
Government and Public Sector
Professional Services
Telecommunications
Information Technology
Human Resources
Banking
Legal
Compliance
Privacy
Records Management
Human Resources
Information Security
Risk Management
Operations
Administrative Services
Corporate Secretariat
Data Protection
Regulatory Affairs
Customer Service
Legal Counsel
Compliance Officer
Privacy Officer
Records Manager
Human Resources Manager
Information Security Officer
Risk Manager
Operations Manager
Administrative Coordinator
Company Secretary
Data Protection Officer
Regulatory Affairs Manager
Customer Service Manager
Medical Records Administrator
Financial Controller
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Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it


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