78 AA 3231184
We, the citizen of RF Ivanov Ivan Ivanovich, sex - male;
date of birth: 10 October 1970; place of birth – Leningrad (passport: 12 34 567890 issued on 05.05.2001 by the 68 Police Department of Moskovskiy district of the city of Saint-Petersburg, department code 782-068),
registered at: Russia, Saint-Petersburg, ulitsa Pilotov 1, building 4, Apt. 40 and living at the same place,
the citizen of RF Ivanova Daria Ivanovna, sex - female; date of birth: 20 July 1980; place of birth – Leningrad (passport: 98 76 543210 issued on 09.09.2001 by the 68 Police Department of Moskovskiy district of the city of Saint-Petersburg, department code 782-068,
registered at: Russia, Saint-Petersburg, Shturmanskaya ulitsa, house 40, building 1, Apt. 20,
give our consent to applying for a visa and a trip of our daughter Ivanova Anna Ivanovna, date of birth 06 July 1999, to Great Britain and back to the Russian Federation in the period from 01 November 2012 to 15 November 2012 accompanied by Petrova Zhanna Petrovna, date of birth 02 June 1966.
We give our consent to the citizen Petrova Zhanna Petrovna to undertake all the responsibility for the life and health of our daughter and entrust her to make all the decisions in case of emergency with regard to our daughter’s rights protection including urgent medical operations if necessary.
Adoption or delay in return are not planned.
The city of Saint-Petersburg 21-09-2012
Ivanov Ivan Ivanovich
Ivanova Daria Ivanovna
On the twenty-first of September two thousand twelve this consent is certified by me, Shaposhnik Alla Georgievna, acting notary.
Consent is signed by the citizen Ivanov Ivan Ivanovich , the citizen Ivanova Daria Ivanovna in my presence. Their identity and capacity is confirmed.
Registered in the register № I - 6565
Collected under rate 600 rubles
Notary Shaposhnik A.G.