You are on page 1of 1

CONSENT LETTER

We, undersigned,

Name : H. ZEFRI JANUAR PRIBADI


Passport/ID No : 1275020101690003
Address : Jl. Mesjid Baiturrahman No. 4B Lk.III Kel. Berngam Binjai
Contact info : +6282167849954

Name : HJ. MASNIARI, ST


Passport/ID No : 1275026302680001
Address : Jl. Mesjid Baiturrahman No. 4B Lk.III Kel. Berngam Binjai
Contact info : +6282167849954

1. Parents of
Name : MUHAMMAD NOVAL FALIH
Passport No. : B9212528

2. Parents of
Name : SITI NAYLA SYAKIRA
Passport No. : B9212527

Hereby inform that we have given our consent to:

Name : ETI ZAHARA


Passport No. : B6269253
Address : Jl. Sibolga No.14 Binjai
Relationship : Sister

To act as a legal guardian, bring the said child for a holiday visit to Malaysia from 31st
January 2018 to 3rd February 2018 and be responsible for the well-being of the child
during the visit. We hereby also inform that we will bear all legal responsibility pertaining to
this child and that this consent is given willingly without duress.

Thus this consent letter is written for immigration clearance purpose.

Signed,

H. ZEFRI JANUAR PRIBADI HJ. MASNIARI, ST

You might also like