Consent for Indirect Collection
(to be completed ONLY if travel agent or representative used)
I give my consent for the CVAC in Côte d’Ivoire operated by IOM to collect my documents and my
personal information from:
Name of Travel Agent and authorised employee or other authorised representative:
_________________
Relationship to Applicant: ________________________
Applicant Signature ____________________________ Date ______________________
Declaration to be signed ONLY
staff
by applicants assisted by the CVAC
with electronic application form.
I received the assistance of the CVAC staff for data entry of my application information. I provided all
information and responses required for the application. I have read the completed and printed application
form and declare that the information provided is true and that the documents I am submitting in support
of my application are genuine and have not been altered in any way.
Name: ___________________________
Signature:___________________________________ Date: _______________
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