EMBASSY OF THE REPUBLIC OF SLOVENIA

WASHINGTON D.C.

DOCUMENT HOLDER STATEMENT

I, undersigned, (surname

and name)____________________________

agree and allow that the

Embassy of the Republic of Slovenia in Washington D.C., in the application for

__________________makes and keeps the photocopy of the passport and/or other personal
documents submitted in the application until the fulfillment of the purpose of the application
or until the statutory limits of documents storage.

Date ______________

Signature: _____________________