APOSTILLE

(Convention de LaHaye du 5 octobre 1961)

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1. Country ________________________________________

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This public document ___________________________________________

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2. Has been signed by __________________________________________
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3. Acting in the capacity of _______________________________________
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4. Bears the seal/stamp of _____________________________________

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_________________________________________________________

CERTIFIED

5. At _______________________
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6. The __________________________

7. By ______________________________________________________
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8. No _____________________________

9. Seal/Stamp: 10. Signature: