Name
Children accompanying holder Forename(s)
Place and date of birth
Sex
* Strike out whichever does not apply.
pages, exclusive of cover.)
(This document contains
(3)
Photograph of holder and stamp of issuing authority Finger-prints of holder (if required)
Signature of holder
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pages, exclusive of cover.)
(4)
1. This document is valid for the following countries:
2. Document or documents on the basis of which the present document is issued:
Issued at
Date...
Fee paid:
Signature and stamp of authority
issuing the document:
(This document contains
pages, exclusive of cover.)
(5)
Fee paid:
Done at..
Fee paid:
Done at...
(This document contains
Extension or renewal of validity.
From
To
Date...
Signature and stamp of authority extending or
renewing the validity of the document:
Extension or renewal of validity
From
To
Date..
Signature and stamp of authority extending or renewing the validity of the document:
pages, exclusive of cover.)
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