Consulate-General Of Brazil Form printable pdf download

CONSULATE-GENERAL OF BRAZIL

80 SW 8

STREET, MIAMI, FLÓRIDA

– FAX: 305-285-6240 – Phone: 305-285-6200

LETTER OF CONSENT

Miami, ___/___/______

We, the parents/guardians hereby identified, authorize the Consulate General of Brazil in Miami to

issue a visa on our child’s passport. Our child is also authorized to travel to Brazil and within the

Brazilian territory for the duration of his/her visa, as follows:

Unaccompanied

under the responsibility of __________________________________________

Father’s

Guardian’s information:

1. Full name: ______________________________________________________________________

2. Country of birth: ________________________________ 3. Is a Brazilian citizen?

YES

Mother’s

Guardian’s information:

1. Full name: ______________________________________________________________________

2. Country of birth: ________________________________ 3. Is a Brazilian citizen?

YES

Child’s information:

1. Full name: ______________________________________________________________________

2. City/State/Country of birth: _____________________ / ___________________/ ______________

3. Date of birth (DAY/MONTH/YEAR) ______ / _________ /_______

3. Has he/she ever been issued a Brazilian Birth Certificate with a Brazilian Consulate/Embassy or

Civil Registrar in Brazil?

YES

4. Has he/she ever been issued a Brazilian passport?

YES

As a guardian, I declare under penalty of perjury according to any applicable Law that I have sole custody, legal guardianship, of

the child identified above.

I/we understand that any knowingly and willfully false or misleading statement or willful concealment of a material fact made by

me/us herein may subject me/us to criminal prosecution under Brazilian Penal Code:

"Article 299: Concealing in public or private document, a declaration which it should contain, or inserting or making false

statement or insert any information other than that which should be written with the purpose of disrupting law, create an obligation

or alter the truth of fact legally relevant.”

__________________________

____________________________

father’s/guardian’s signature

mother’s/guardian’s signature

Sworn to (or affirmed) and subscribed before me this ______ day of __________________, ________, by

_________________________________ and _____________________________, ( ) personally known

( ) produced Identification _____________________________________________________________

______________________________________

Signature of Notary Public

Consulate-General Of Brazil Form

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