To The Comptroller of Customs, Nassau
I /we
of Coopers Town, March Habour Abaco Bahamas
Hereby authorized Champion Shipping & Brokers on my/our *  behalf
to declare the value and other matters relating to the goods concerned, in respect of all goods imported by me/us*, hereby declare that the signature endorsed below is the specimen of the signature which will be used by the person/company* authorized by me/us*.