被致谢者的written permission

日前投稿返回，杂志有一条回复是：

Authors should obtain written permission from all individuals who are listed in the "Acknowledgments" section of the manuscript, because readers may infer their endorsement of data and conclusions. 

意思应该是被致谢这出具一份 written permission并签字 ，请问这个应该怎么写？有没有模板？