AUTORIZAÇÃO PARA CONCESSÃO DE ... .br
CONSULATE GENERAL OF BRAZIL IN BOSTON
Visa Department
175 Purchase Street
Boston, MA, 02110
contato.boston@.br
PARENTAL AUTHORIZATION FOR BRAZILIAN VISA APPLICATION
AUTORIZAÇÃO PARA EMISSÃO DE VISTO PARA MENORES
|1 - MINOR INFORMATION INFORMAÇÃO DO/DA MENOR |
|Full Name Nome e sobrenomes |
| |
|Place Of Birth (City, State, Country) |Date of Birth Data de Nascimento |
|Lugar de Nascimento (Cidade, Estado, País) | |
| |Day Dia |Month Mês |Year Ano |
| | | | |
|Passport Information |Issued by (Country and Issuing Office) |Issued on Data de Emissão |
|Number Número |EXPEDIDO POR (País e Autoridade Expedidora) |Day Dia |Month Mês |Year Ano |
| | | | | |
|2 –PARENTS/ GUARDIANS INFORMATION INFORMAÇÃO DOS PAIS/RESPONSÁVEIS |
|Guardian 1/Mother’s Full Name (according to minor’s birth certificate) Nome |Guardian 2 / Father’s Full Name (if mentioned on minor’s birth certificate) |
|completo da mãe ou responsável 1 |Nome completo do pai ou responsável 2 (se houver) |
| | |
|Passport or ID Passaporte ou documento de identidade |Passport or ID Passaporte ou documento de identidade |
|Number Número |Issued on Data de Emissão |Number Número |Issued on Fecha de Emissão |
| |Day Dia |Month Mês |Year Ano | |Day Dia |Month Mês |Year Ano |
| | | | | | | | |
|Issued by (Issuing Office) |Country of Birth |Issued by (Issuing Office) |Country of Birth |
|EXPEDIDO POR (Autoridade Expedidora) |País de Nascimento |EXPEDIDO POR (Autoridade Expedidora) |País de Nascimento |
| | | | |
|3 – FORMAL STATEMENT DECLARAÇÃO FORMAL |
|I/We authorize the issuance of a Brazilian Visa for the above minor |
|(Autorizamos a emissão de visto para o Brasil para o/a menor acima) |
|Place Local |Date Data |Place Local |Date Data |
| |Day Dia |Month Mês |Year Ano | |Day Dia |Month Mês |Year Ano |
| | | | | | | | |
|Guardian 1/ Mother’s Signature Assinatura da mãe ou responsável 1 |Guardian 2 / Father’s Signature Assinatura do pai ou responsável 2 |
| | |
|4 – NOTARY’S CERTIFICATION IF PARENT(s) WILL NOT BE PRESENT AT VISA APPLICATION DROP OFF OR APPLICATION WILL BE SUBMITTED BY MAIL: |
|CERTIFICAÇÀO DO NOTÁRIO: caso os pais ou responsáveis legais não estejam presentes na entrevista de solicitação de visto ou enviem o pedido por correio. |
|NOTARY’S CERTIFICATE OF ACKNOWLEDGEMENT FOR FATHER’S SIGNATURE |FOR|NOTARY’S CERTIFICATE OF ACKNOWLEDGEMENT FOR MOTHER’S SIGNATURE |
| |NOT| |
| |ARY| |
| |PUB| |
| |LIC| |
| |USE| |
| |ONL| |
| |Y | |
|State of ___________________ County of _________________________________ | |State of ___________________ County of _________________________________ |
|On_______/________/_________, before me personally appeared | |On_______/________/_________, before me personally appeared |
|____________________________________________________, | |____________________________________________________, |
|□ personally known to me -- OR – | |□ personally known to me -- OR – |
|□ proved to me on the basis of satisfactory evidence to be the person(s) | |□ proved to me on the basis of satisfactory evidence to be the person(s) |
|whose name(s) is/are subscribed to the within instrument and acknowledged to| |whose name(s) is/are subscribed to the within instrument and acknowledged to |
|me that he/she/they executed the same in his/her/their authorized | |me that he/she/they executed the same in his/her/their authorized |
|capacity(ies), and that by his/her/their signature(s) on the instrument the | |capacity(ies), and that by his/her/their signature(s) on the instrument the |
|person(s) or the entity upon behalf of which the person(s) acted, executed | |person(s) or the entity upon behalf of which the person(s) acted, executed |
|the instrument. WITNESS my hand and official seal. | |the instrument. WITNESS my hand and official seal. |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |(Notary’s signature, stamp and commission expiration) |
|(Notary’s signature, stamp and commission expiration) | | |
Note: 1) It is mandatory to add the original birth certificate or its notarized/certified copy on minor’s visa applications.
2) Children of Brazilian nationals must additionally present a declaration of non-citizenship.
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