TO THE COMPETENT BODIES
From the citizen —
(place of residence: —,
Passport — # —, issued by the —- Regional Department
of Internal Affairs of Ukraine in — oblast on —,
identification number —)
I, —, father, give my consent to my under age daughter, — (born on -), going abroad to Thailand.
I inform that in accordance with the asset 6 of the Law of Ukraine “About the procedure of departure and entrance into Ukraine” there are no grounds to circumscribe the right of —- to go abroad.
Father Signature —
June 04, 2007, I, —-, private notary of the —- regional notarial district in — oblast, certify the authenticity of the signature of the citizen — which was made in my presence.
Person of the citizen — who signed the document is identified.
Registry # —
Payment received in accordance with the asset 31 of the Law of Ukraine “About Notary activities”
Private notary: Signature
— # —
Round official seal
Attention! This blank has a multilevel falsification protection.
Ministry of Justice of Ukraine