CONSENT

I, The applicant’s surname, name, patronymic, The applicant’s date of birth, The applicant’s passport data, residing at: The applicant’s address, give my consent for The child’s full name The child’s date of birth to travel outside the country together with The accompanying person’s surname, name, patronymic, to The state of departure The purpose of the journey from The date of departure till The date of return.

Adoption or delay of The child’s surname, name, patronymic outside the Russian Federation is not stipulated.

The Applicant Ivanov Ivan Ivanovich

Date 01-01-2016
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