CONSULADO-GERAL DO BRASIL AUTORIZAÇÃO DE EMISSÃO …
[Pages:1]CONSULADO-GERAL DO BRASIL
AUTORIZA??O DE EMISS?O DE PASSAPORTE E ANOTA??O DE AUTORIZA??O DE VIAGEM PARA MENOR BRASILEIRO PASSPORT AUTHORIZATION AND TRAVEL ENDORSEMENT FOR BRAZILIAN MINORS
IDENTIFICA??O / IDENTIFICATION
M?E/MOTHER:___________________________________________________________________________
(PREENCHER O NOME COMPLETO / FILL UP WITH THE FULL NAME)
Identidade/passaporte n?____________________________________ ?rg?o expedidor____________________________
ID/PASSPORT N?
ISSUED BY
PAI/FATHER: ____________________________________________________________________________
(PREENCHER O NOME COMPLETO / FILL UP WITH THE FULL NAME)
Identidade/passaporte n?____________________________________ ?rg?o expedidor________________________
ID/PASSPORT N?
ISSUED BY
FILHO(A)MENOR:________________________________________________________________________________
UNDERAGE CHILD:
AUTORIZO(AMOS) A EMISS?O DE PASSAPORTE. ISSUE A PASSPORT.
QUANTO A ANOTA??O DE AUTORIZA??O DE VIAGEM DO BRASIL PARA O MENOR, ESCOLHA UMA DAS OP??ES ABAIXO: ABOUT THE BRAZIL TRAVEL ENDORSEMENT FOR MINOR, CHOOSE ONE OF THE OPTIONS BELOW:
O TITULAR EST? AUTORIZADO PELO(S) GENITOR(ES) A VIAJAR DESACOMPANHADO. THE MINOR IS AUTORIZED BY THE PARENTS TO TRAVEL UNATTENDED.
O TITULAR EST? AUTORIZADO PELO(S) GENITOR(ES) A VIAJAR COM UM DELES, INDISTINTAMENTE. THE MINOR IS AUTORIZED BY THE PARENT TO TRAVEL WITH ONE OF THEM, INDISTINCTLY.
O TITULAR EST? AUTORIZADO PELO(S) GENITOR(ES) A VIAJAR ACOMPANHADO POR TERCEIRO: THE MINOR IS AUTORIZED BY THE PARENTS TO TRAVEL WITH A THIRD PARY:
________________________________________________________________________________, ID/PASSAPORTE N?__________________________.
(PREENCHER O NOMECOMPLETO / FILL UP THE FULL NAME)
QUANTO AO PRAZO DE VALIDADE DA AUTORIZA??O DE VIAGEM: ABOUT THE EXPIRATION DATE OF THE TRAVEL ENDORSEMENT:
PELO PRAZO DESTE DOCUMENTO THE EXPIRY DATE OF THE DOCUMENT
VALIDADE AT?: ________/___________/____________
Validity up:
dia/(day ) / m?s(month ) / ano(year)
_______________________, ________/ __________/ ________
Local/Place
Dia(Day) M?s(Month) Ano(Year)
__________________________________ Assinatura do pai/ FATHER'S SIGNATURE
___________________________________ Assinatura da m?e/ MOTHER'S SIGNATURE
O(s) genitor(es) poder?(?o) assinar esta autoriza??o perante funcion?rio do Consulado ou perante um "notary public".
Preenchimento obrigat?rio quando o documento for assinado perante "notary public"/Complete notarization is required when signing before a "notary public".
On this ____ day of ___________, 20___, before me, the undersigned notary public, personally appeared: _________________________________________and________________________________ (name of document signer), proved to me through satisfactory evidence of identification, which were ____________________________, to be the person whose name is signed on the preceding or attached document in my presence.
Assinatura official e carimbo do "notary public"
Official signature and seal of notary public
E:\20150618FORMULARIO DE AUTORIZA??O DE VIAGEM.doc
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