Authority Letter for Collection of Passport

Date : J ul 0 7 , 2 0 1 6
This is to certify that I PER U MA L J A YA SU N D A R A M K A VITH A authorize my representative whose specimen signatures is
given below, to collect the sealed envelope on my behalf.
Fill the following de ta ils
Name of the Agency
Representative Name who will collect the Passport
ID Number of the Representative
Contact Details

Address
Telephone No.

Please n o te th at rep resen tative mu st b rin g th e o rig in al Id en tity p ro o f, fo r verificatio n

p u rp o se.
T h e p assp o rt / d o cu men t will n o t b e h an d ed o ver with o u t o rig in al Id en tity p ro o f.

Spe c im e n Signa tur e of the a uthor ize d

A pplic a nt Signa tur e

r e pr e s e nta tiv e

Pa s s por t N um be r : F8 1 4 6 4 7 6

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