Переклад Заява про згоду на виїзд дитини за кордон, мати



State emblem


Citizen: —

(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

Private notary


Attention! This blank has a multilevel falsification protection.

Ministry of Justice of Ukraine