請問一下行政許可變更申請書格式是怎樣的

行政許可變更申請書
申請人：____________________________________________________________________________
地址：______________________________________________________________________________
法定代表人(委託代理人)：__________________________________________________________
申請變更事項：______________________________________________________________________
提交材料目錄：
1、____________________________________________________________________________________________
2、_________________________________________________________________________
3、____________________________________________________________________________________________
4、____________________________________________________________________________________________
提交材料頁數：________________________________________________________________________________。