I. Child's Information

• Child's Full Name: [Child's Full Name]

• Date of Birth: [Child's Date of Birth]

• Place of Birth: [Child's Place of Birth]

• Gender: [Child's Gender]

• Parent(s) or Legal Guardian(s):

  • Mother's Full Name: [Mother's Full Name]

  • Father's Full Name: [Father's Full Name]

  • Legal Guardian's Full Name: [Legal Guardian's Full Name]

• Address: [Child's Address]

• Contact Number: [Child's Contact Number]

II. Parental Consent

I, [Parent/Guardian Name], the [child relationship], hereby give my consent for the issuance of a passport for my child, [Child's Full Name], born on [Child's Date of Birth]. I confirm that I am legally authorized to provide consent for the passport application on behalf of the child.

III. Notary Certification

I, [Your Name], a duly commissioned Notary Public in and for [State], certify that on this [Date], [Parent/Guardian Name] personally appeared before me, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that [he/she/they] executed the same for the purposes therein contained.

IV. Instructions for Parent or Legal Guardian

• Ensure all sections of the application form are completed accurately.

• Attach required documents, including proof of citizenship, parental identity, and relationship to the child.

• Submit the completed application along with this notarized form to the appropriate passport office.

V. Additional Notes

• Any alteration or correction made to this document must be initialed by the signatory and the notary public.

• This notarized form is valid for a period of [Validity Period] from the date of notarization.

VI. Disclaimer

This notary service does not verify the accuracy or truthfulness of the information provided by the applicant or signatories. It solely certifies the identity of the signatories at the time of notarization.

Notary Public Name: [YOUR NAME]

[DATE SIGNED]

Notary Seal (if applicable): [SEAL]

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