828266855051

Aleksandre Iashagashvili
47, Melita St, Valletta, , Malta, VLT 1122
Valletta Malta VLT 1122
Georgia

Officer in charge Criminal Records Office,

I Aleksandre Iashagashvili 15BB84875 currently residing at 47, Melita St, Valletta, , Malta, VLT 1122 Valletta Malta VLT 1122 Georgia, hereby
authorise Criminal Records Office Personnel to issue my Maltese Police Conduct Certificate and send it to me personally by registered post on the
address declared above as currently I am not living in Malta.
Please find below the information needed:

User Details
Date of birth: 22/3/1998
Place of birth: Georgia

User Parent's details

Name: Tengiz
Surname: Iashagashvili
Previous Surname (if applicable):

Name: Ia
Surname: Inashvili
Previous Surname (if applicable):

Regards,
Aleksandre Iashagashvili

(Signature)
(The signature must match the signature on the Passport/Identification Document)