未成年者渡航同意書

CONSENT FOR INTERNATIONAL TRAVEL OF CHILD UNDER 18 YEARS OLD WITH ONLY ONE PARENT

(一方の親のみが同伴する18歳未満の子の海外渡航に対する同意書)

We, ________ and ________, declare that we are the parents of the following child:

________, gender: Male, born on the following date: ________, passport number: ________.

The above child has our consent to travel to ________ from ________ to ________ under the responsibility of his mother, ________, passport number ________.

Mother accompanying the child (子に同伴する母)

(signature; 下記に署名してください)


_____________________________

________

Date of signature (右に署名日を記入してください): ___________________

Passport number: ________

Address: ________

Phone number: ________

Father who gives consent (渡航同意を付与する父)

(signature; 下記に署名してください)


_____________________________

________

Date of signature (右に署名日を記入してください): ___________________

Address: ________

Phone number: ________

WITNESS (証人)

(882252552, 82 228288552; 5181815121212151812121812121 518181512121215181212181

____________________________
Name (証人の氏名を右に記入してください): ____________________________

Date (証人の署名日を右に記入してください): ____________________________