I, the undersigned [full name as in passport]: _______________________________, holder of ordinary passport number (only passport is accepted!): __________________________, hereby mandate Mr./Ms. [full name as in passport of authorized representative/ agent] _______________________________, holder of the passport number _______________________________, as a representative to submit my visa application with VFS Global.

Thank you and kind regards

Name and Surname: _______________________________

Place/ Date: _____________

Signature: ______________________________

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