C??NG H?A X?? H??I CH? NGH??A VI?T NAM
???c l??p - T? do - H???nh ph??c
_______________
???N XIN V??NG M??T KHI N??P H? S? GHI CH?? LY H?N V?? GI??Y ?Y QUY??N
(POWER OF ATTORNEY)
K?nh g?i: S?? T? ph??p
t?nh/th?nh ph?.....................................
To: The Department of Justice of
T??i, ng???i k?? t??n d??i ???y, :...........................................................................................
I, the undersigned,
Sinh ng?y.................. th??ng .........n??m...............
t???i:..............................................................
Date of birth dd mm yyyy place of birth
Mang h? chi???u s?:...............................................
Passport number
???a ch? th???ng tr??:................................................................................................................
Permanent address
Do b??n c??ng vi?c ch?a v?? Vi?t Nam ngay ????c, l?m
???n n?y xin ????c ph?p v???ng
m??t khi n?p h? s?? ghi ch?? ly h??n v? ?y quy??n cho
As my work does not permit me to go to Vietnam
now, hereby request permission
to be absent in submitting my devorce annotation
dossier and entrust
H?? v? t??n:..........................................................................
Full name
Sinh ng?y................th??ng..............n??m...................t???i:....................................
Date of birth dd mm yyyy place of birth
S? CMND.......................................N??i
c???p:.....................................................
ID Card Number issuing
authority
thay t??i l?m c??c th? t??c ghi ch?? ly h??n
to act on my behalf in completing all the procedures
concerning my divorce
annotation and in submitting the application package for a marriage
certificate
t???i S?? T? ph??p....................................................
at the Justice Department of
L?m t???i.............................................., ng?y
..........th??ng..........n??m.............
dd
mm yyyy
Signature
H?? v? t??n:....................................
Full name
