Pełnomocnictwo wnioskodawcy dla organu centralnego państwa wezwanego (wersja angielska EN)

AUTHORISATION Dear Sirs, Please accept this letter as written authorizstion, as may be required by Article 28 of the Convention on the Civil Aspects of International Child Abduction done at the Hague on October 25, 1980, empowering the central Authority for................................................. or their designated representative, to act on my behalf

(Fill the gap)

(name of the country)

Date: *

Place: *

Signature: *

Name of applicant: *

Date of birth: *