(last name — was changed into —- in accordance
with the divorce certificate series — # —-,
issued on January — by the registry office
in the town of — in — oblast)
place of residence: —,
I, —, mother, passport series — # —, issued on — by —- Regional Department of Internal Affairs of Ukraine in —- oblast
give my consent to my under age daughter, —- (born on —; place of residence: —), studying in the educational establishments of the —-.
I inform that in accordance with the asset 6 of the Law of Ukraine “About the procedure of departure and entrance into Ukraine by the citizens of Ukraine” there are no grounds to circumscribe the right of — to go abroad.
Signature: 1. Signature —
—– city of — Ukraine
I, —, private notary of the — municipal notarial district, certify that the statement above is signed by the citizen — (place of residence: —-) who personally came to me and is known to me as a person, stated in this document, signed the document in my presence and properly confirmed the drawing up of this document.
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