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Adoption of children
05 December 2012 20:34

General provisions (Assistance (English) (Assistance in Ukraine (ukrainian)

The matters of International Adoption in Ukraine are adjusted by such legislative acts as follow:
Family Code of Ukraine;

„The Order of transfer of children, who are the citizens of Ukraine, on adoption to the citizens of
Ukraine and foreign citizens and realization of the control behind conditions of their residing in new
families”, authorized by the Decision of the Cabinet of Ministers of Ukraine on August 28, 2003, #1377.

The adoption of children will be carried out under the application of person wishing to adopt the child in
the judicial order. The presence of the prospective adoptive parents at the Court is obligatory.

The registration of the foreign citizens, who wish to adopt children, is conducted by the National Adoption
Center (NAC) at the Ministry of Education of Ukraine extremely.

THERE ARE NO UKRAINIAN ADOPTION FEES EXCEPT THOSE FOR COURT FILING, NOTARIAL, TRANSLATION AND SIMILAR SERVICES.

Foreigners wishing to adopt a child from Ukraine must register with the National Adoption Center (see Documentary Requirements below) to begin adoption proceedings in Ukraine. The National Adoption Center is operated as part of the Ministry of Education and is the ONLY legal Ukrainian authority that maintains a database of children available and qualified for both domestic and international adoptions.

The National Adoption Center is involved in international adoptions from the initial to the final stage, e.g. from the moment prospective parents apply for registration to the point when, once a child has been identified, the case is forwarded to a court for adjudication.

The National Adoption Center processes the documents submitted by adopting parents and enters them into their database within twenty working days. Once an application is approved, the prospective adopting parents will receive an invitation to visit the Adoption Center. When adopting parents arrive in Ukraine, the Adoption Center shows them information about orphans available for international adoption within the parents' specified age range. The Center then issues a letter of referral to allow the prospective parents to visit orphanages to meet, select, and establish contact with a child. Along with the letter of referral, adopting parents will be given their documents, bound, numbered, sealed, and signed by an official in charge of the Adoption Center, with a separate sheet specifying the number of pages and the prospective parents' registration file code.

Adoption Center in Kiev, Ukraine
27-A Taras Shevchenko Boulevard
Kiev, Ukraine 252032
Tel # (380)(44) 246-54-31/32/37/49
Fax # (380)(44) 246-5452/62

Please keep in mind that translators or interpreters are not available on the staff of the Adoption Center, so callers or visitors have to be prepared to speak Ukrainian, or have their own interpreters. The intermediary commercial activity concerning adoption of children, transfer them under guardianship or on education in families of the citizens of Ukraine or citizens of other states is forbidden, and there will be NO fees except those for court filing, notarial and translation and similar services.

The Ministry of Education of Ukraine informs about the recent changes in the procedures of the Center
for Child Adoption in Ukraine.

According to the information received by the Embassy, the Center for Child Adoption has introduced new temporary regulations on registration of prospective adoptive parents' dossiers for adoption and placing them on a waiting list.
It is a temporary procedure, which will be used until the Ukrainian Government approves the final regulation.
According to these regulations, after official registration of the adoption dossiers, prospective adoptive parents will be notified by mail by the Center for Child Adoption that they have been registered with the Center for Child Adoption. After a family receives a letter to this effect, they should inform the Center for Child Adoption about the desired appointment date. The Center for Child Adoption will then schedule them for the next available dates and send invitations directly to the families. Upon receiving invitations adoptive parents should confirm the appointment date via mail, fax or e-mail. The enter for Child Adoption plans to serve ten families per day.

ADOPTION CENTER DATABASE

The National Adoption Center recommends prospective adopting parents who wish to adopt two or more children to submit a separate, authenticated dossier for each child. However, submission of two or more dossiers is not a guarantee adopting parents will allow adopt two or more children. Current adoption policy is for adopting parents to adopt one child at a time, unless you adopt a sibling group.

Adoption Center representatives will not meet with prospective adopting parents who arrive in Ukraine without an appointment or on a day other than when they are scheduled for an appointment. Effective January 1, 2004, the NAC no longer releases information about adopting parents' registration numbers and dates of their appointments to third parties, including to facilitators or others who have obtained the parents' Power of Attorney.

All communication between the Center and prospective adopting parents is conducted only by direct exchange of official letters. The NAC sends two standard letters to adopting parents:

(1) notification regarding the date and registration number of a dossier and a suggested month for an
appointment, and,
(2) an official invitation for an appointment with the NAC, indicating a specific date and time.

The Center currently uses normal postal mail when sending these letters, which can delay notification by three or more weeks. In order to expedite and facilitate communication, the NAC advises that families may wish to include one or two prepaid, self-addressed international express mail envelopes (DHS or FedEx) with their dossier. These envelopes are used by the NAC for mailing registration and appointment letters to the families. The inclusion of these envelopes with a dossier is completely optional.

The absence/presence of prepaid envelopes has no relation to expediting the actual process of registration of a dossier or the scheduling of an appointment date.

BASIC DOCUMENTS REQUIREMENTS FOR REGISTRATION WITH THE ADOPTION CENTER

Ukrainian law states that foreign citizens wishing to adopt Ukrainian children must submit a petition to the Adoption Center, requesting to be registered as prospective adoptive parents and to be permitted to visit orphanages in order to select, meet and establish contact with an orphan.

The following documents must be part of the adoption application submitted to the Ukrainian adoption
authority:

1) Home Study, issued by a competent authority in the adopting parents' country, attesting to their eligibility, specifying their housing and living conditions, containing their curriculum vitae, and other information. If a home study is issued by a non-governmental entity (a private agency or social worker), a copy of the license authorizing this entity to conduct pre-adoption reviews must be attached.

2) Entrance and permanent residence permit for the adopted child, issued by the competent authority in the adopting parents' country.

3) Proof of income. Bank statements showing the adopting parents' yearly income, tax returns and a statement from adopting parents' employer indicating salary. To avoid confusion, please do NOT copy blank pages of tax returns.
4) Bill of health. Adopting parents are given a specific medical form to complete. Adopting parents must demonstrate that they are specifically not suffering from any kind of psychiatric, communicable, internal, skin or venereal diseases. There must also be a statement that parents are not drug addicts, and that parents are free from AIDS and syphilis. Medical certificates for prospective adopting parents should be issued on official letterhead of the medical office where the examination took place. Alternatively, the document can bear a stamp/seal of approving clinic/doctor, if available. The doctor's signature must be notarized. If letterheads/seals are not available, the NAC requests that a copy of the doctor's medical license be attached to the form.

5) Copy of the marriage certificate (if applicants are a married couple).

6) Copies of the passports or other identification papers of prospective adopting parents. A copy of the Permanent Resident Cards should be included, if parents are not citizens of Vietnam.

7) "No criminal record" statement supplied by a competent authority for each adopting parent, attesting to his/her having no criminal record at the State level. If the criminal background check statement is issued by the local sheriff/police office (not State authorities), it should clearly indicate that each prospective adopting parent has no criminal record in the state of his/her residence.

8) Adoptive parents' commitment to register their adopted child with the Ukrainian Embassy or Consulate in their new home country within one month of the completion of adoption. Adopting parents also agree to supply information about the adopted child's living conditions and educational progress to the Ukrainian Consular Office at least annually during the first 3 years following the adoption. Under Ukrainian law, an adopted child remains a Ukrainian citizen until age 18, at which time the child can decide to remain a Ukrainian citizen.
Please note that all eight documents must be separate documents; one cannot be part of another. The documents remain valid for one year from the date of issuance. The Adoption Center prefers that the documents be translated in Vietnam, but understands that it may be difficult to find qualified translators. Therefore, the Center allows facilitators to come to the Center with a properly notarized, authenticated and translated power of attorney to take the documents to have them translated and notarized locally.

GROUNDS FOR DENIAL TO REGISTER

No standards have been established by law for approval or denial of prospective parents' applications to register. Eligibility is determined through a personal interview at the Adoption Center.

However, violation of adoption procedures and regulations (e.g. visiting an orphanage without the Center's permission, meeting and selecting children for adoption prior to registration, not arriving for an interview, etc.) can be considered as grounds for denial to be registered with the Adoption Center. In case of registration denial, prospective parents must be notified of the denial in writing and all the documents they submit should be returned to them.

MEETING A CHILD

Once the Adoption Center issues permission for prospective parents to visit orphanages, parents may go and meet a child, check medical records and establish personal contact with a child.

COURT HEARING

It is important to mention that, in compliance with recent changes in and amendments to the Family and Marriage Code of Ukraine, the power to approve or deny an adoption is solely with an individual judge. The judge's decision, in turn, will be based on a review of various documents of each individual adoption case during the court hearing, where adoptive parents have to be present. The law states that adoptive parents must attend the hearing. The Adoption Center has stated that this requirement will be strictly enforced following the recent resolution of the Supreme Court of Ukraine. Adopting parents must attend the hearing. In cases where one of the parents cannot be present at the hearing due to a compelling reason (e.g. major surgery, disability etc.), a judge may permit one parent to provide a power of attorney to another parent.

The set of documents for the adoption case is presented to the judge after being carefully examined by the Adoption Center. As a general rule, the judge's decision is announced and issued the day of the hearing. However, unless the judge grants an "immediate execution," the decision does not take effect for one month. Such waivers are granted only when there is clear evidence that a delay in executing the court decision is not in the best interest of the child (for example, damage to health). During the one-month period, the adoption can be appealed. Once the decision takes effect, the new adopting parents are granted parental rights and legal responsibility for the child.

OBTAINING A TRAVEL DOCUMENT

RAGS (Ukrainian Office of Vital Records) will issue a post-adoption certificate of birth for an adopted child based on the final court decree and the original (pre-adoption) birth certificate only. Please remember that the pre-adoption birth certificate is not be returned to the adopting parents. Therefore, please make sure to that you make a copy before handing it over to RAGS authorities.

Adopting parents should make sure that there are no discrepancies in the spelling of names of the parents and children in the court decree. If noticed, please ask the court clerk to correct them immediately. Failure to do so may cause delays in issuing the post-adoption birth certificate and in authenticating Ukrainian documents.
Once the post-adoption birth certificate is obtained, parents may apply for a passport for their child at the local VVIR (Ukrainian Office of Visas and Registration).

Parents are required to present a written and notarized statement requesting that the travel document be issued. The post-adoption birth certificate, final court decree, and 4 passport-size photos of the child have to be submitted along with the statement. The new name of the adopted child in the travel document is spelled in English transliterated from Ukrainian, so it may look different from what appears on the parents' passport. There is no need for concern as long as the child's name in Ukrainian on the travel document is the same as in the court decree. However, parents can request that the correct English spelling be noted on the blank page in the passport.

At the time the passport is issued, a special, mandatory stamp is put in it showing that the child is departing Ukraine for permanent residence abroad. It is called a "PMP-stamp" in Ukrainian. Although under Ukrainian law immigration authorities have up to 10 working days to issue passports or travel documents for adopted children, they are often issued before then, especially if the child requires medical care.

CONSULAR REGISTRATION OF ADOPTED UKRAINIAN CHILDREN

In accordance with Ukrainian Law, the Embassy should include your child (children) adopted in Ukraine, into the list of Ukrainian citizens residing in Vietnam.

In order to process appropriate paperwork you should present to the Embassy following documents:
Completed registration form;

Your child(ren)'s original passport(s) (Travel document of a child);

A copy of the Ukrainian Court's Decree on adoption (in Ukrainian).

In case you change your place of residence, you are also required to inform the Embassy.
Please be advised that you should submit your application to the Ukrainian Embassy that has jurisdiction over the region of your residence.

IMPORTANT: The Consular District (the area assigned to a Consular Post for the exercise of consular functions - Article 1 of the Vienna Convention on Consular Relations and Optional Protocols, 04/24/1963) of the Consulate General of Ukraine in Chicago.

Please be informed that to apply for a new Ukrainian passport for your child(ren) you must submit to the
Embassy of Ukraine the following documents:

Child's original passport (Travel Passport of a Child);
Completed application form;
2 color passport-size pictures;
Photocopy of the child's birth certificate;
Photocopy of the child's Social Security card and Permanent Residence (if any) Card;

ANNUAL REPORT ON ADOPTED CHILD FROM UKRAINE

The Ukrainian legislation requires that adoptive parents provide the Ukrainian Embassy with annual reports on adopted child (children).

Please be so kind as to send annual reports to the Ukrainian Embassy once a year for the first three years after adoption, and then once every three years until the child reaches the age of 18.

The Embassy of Ukraine will be grateful for your detailed reports about adopted child's (children's) living conditions and development and pictures of your family.

Please fill it out and submit it to the Ukrainian Embassy that has jurisdiction over the district of your residence.
Processing times, requirements and fees are subject to change without notice.

The information on this web-site is provided as a public service, but we cannot guarantee that the information is current or accurate. Readers should verify the information before acting on it.

Medical form 

1.

__________________________________________________________________________________________________________________________________________________________________

Family name, first name, middle name:

__________________________________________________________________________________________________________________________________________________________________

Date and place of birth:

___________________________________________________________________________________________________________________________________________________________________

Place of permanent residence (address):

__________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________

2.

Results of medical examination

Dermatologist__________________________________________________________________________________________________________________________________________________________________ (diagnosis) (date)

Gynecologist/Proctologist __________________________________________________________________________________________________________________________________________________________________ (diagnosis) (date)

Psychiatrist

__________________________________________________________________________________________________________________________________________________________________ (diagnosis) (date)

Phthisiologist (TB specialist)

__________________________________________________________________________________________________________________________________________________________________ (diagnosis) (date)

Physician

__________________________________________________________________________________________________________________________________________________________________ (diagnosis) (date)

Narcologist (drug/alcohol abuse) __________________________________________________________________________________________________________________________________________________________________ (diagnosis) (date)

Blood tests

Wassermann reaction (syphilis test)__________________________________________________________________________________________________________________________________________________________________ (date, number, result)

HIV __________________________________________________________________________________________________________________________________________________________________ (date, number, result)

3.

Conclusion __________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________

Doctor

_________________________________________________________________________________

(signature) (printed name)

4.

Clinic's or doctor's _________________________________________________________________________________

Seal                                               "______" ________________ 200___

Notarization

REGISTRATION FORM

for citizens of Ukraine / adopted foreign parents /

residing in Vietnam

АНКЕТА

для громадян України, які мешкають у В’єтнамі

Affix a recent photo here \

Фотографія

1.                 

Last name / Прізвище

First name / Ім’я

Middle name

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

2.                 

Date of birth / Дата народження

__________________________________________________

 Day / ДеньMonth /МісяцьYear /Рік

3.                 

Place of birth / Місце народження

4.                 

Names of adoptive parents / Ім’я батьків, що усиновили (удочерили) дитину

Father / Батько_____________________________________

Mother / Мати______________________________________

5.                 

Current address of the child / Адреса місця проживання

Home phone / Дом.телефон

Work phone / Служб.телефон

Fax / Факс

__________________________________________________

____________________________________________________________________________________________________

1.       (_____)________________________

2.       (_____)________________________

3.       (_____)________________________

6.                 

Last known address in Ukraine / Останнє місце проживання в Україні

__________________________________________________

____________________________________________________________________________________________________

7.                 

When and from where entered Singapore / Коли та звідки прибув до Сінгапуру

Place / Місце___________________________________

Date / Дата ____________________________________

8.                 

Passport or travel Document / Паспорт або інший проїзний документ

Number / Номер _______________________________

Date of issue / Дата видачі _______________________

Issuing agency / Орган, що видав _________________

9.                 Father’s signature / Підпис батька _____________________________ Date / Дата_______________

10.             Mother’s signature / Підпис матері_____________________________ Date / Дата_______________

For office use only

----------------------------------------------------------------------------------------------------------------------------------

Анкету прийняв _______________________________________ “_____”___________________200__р.

                                               (підпис)

 IMPORTANT. Please note:
Please include 8-10 recent photos of your child with this report. Please identify photos on the back with a china marker, felt tip pen of an address label.
Include a photocopy of any medical, therapist or psychological reports if any occurred in this month.
Annual report on adopted child from Ukraine need not authentication.

BIOGRAPHICAL INFORMATION

Child’s name(s) after adoption:

Child’s name(s) before adoption:

 Date of birth:

Day

Month

Year

 Date of adoption:

Day

Month

Year

 Child’s place of birth:

 Parent name(s):

 Parent’s address:

 Phone / Fax /E-mail:

MEDICAL INFORMATION

Date of last medical exam: ______/______/______ (Month/Day/Year)

Height: _________________________

Weight: _________________________

Result of general check-up (major illnesses and hospitalizations):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

INFORMATION ON CHILD’S DEVELOPMENT

Personality Development:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________

New Accomplishments / Achievements:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________

DAILY ROUTINE / LIVING CONDITIONS

Diet, Eating Habits, Sleep, Napping Patterns:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________

Likes and Dislikes:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________

ADJUSTMENT TO A NEW ENVIRONMENT

Interaction With Immediate Family:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acceptance by extended family:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ADDITIONAL COMMENTS OR INFORMATION

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Adoptive father’s signature _______________________ Date (month/day/year): ____/____/______

Adoptive mother’s signature ______________________ Date (month/day/year): ____/____/______     

Adoption of Ukrainian children

We express our sincere appreciation to the adopters for adopting a citizen of Ukraine and hope to find understanding on the need to comply with the legislation of Ukraine

Consular Registration of Adopted Ukrainian Children

In accordance with Ukrainian Law, the Consular Office of the Embassy of Ukraine to Vietnam should include your child (children) adopted in Ukraine into the list of Ukrainian citizens permanently residing in Vietnam.

In order to complete an appropriate paperwork you must mail to the Consular Office the following documents:

1. Filled application (below)

2. Filled registration form (below) (example);

3. Your child's (children's) original passport(s) and the copy of the pages of the passport(s);

4. Your child's (children's) birth certificate(s);

5. The copy of the second and third pages of the US passport(s) of adoptive parents;

6. An original and a copy of the Ukrainian Court's Decree on adoption (in Ukrainian) and

7. 1 passport-size photo.

Please include a return self-addressed postage-paid envelope (for FedEx - account number is required; credit card number is not acceptable).

Failure to submit all required documents may result in a delayed registration.

In case you change your place of residence, you are also requested to inform the Consular Office.

Please be sure to send your child’s registration documents to the Consulate that has jurisdiction over the district of your residence:

Consular Office of the Embassy of Ukraine (Vietnam Cambodia)

Address:6 Le Hong Phong, Ba Dinh dist., Hanoi, Vietnam

E-mail: emb_vn@mfa.gov.ua

Annual Post-Placement Report on Adopted Child from Ukraine

The Ukrainian legislation requires adoptive parents to provide information about the adopted child's living conditions and educational progress to the Consular Office of the Embassy of Ukraine annually during the first three years following the adoption and once every three years thereafter, until the child's 18th birthday.

The Consular Office of the Embassy of Ukraine will be grateful for your detailed reports about adopted child's (children's) development and pictures of your family.

The form of annual report on adopted child from Ukraine you can find here.

To facilitate communication, the reports can be forwarded via e-mail to: adoption@ukremb.com  (adoption.ukremb@gmail.com ) or can be sent by mail to the Consular Office of the Embassy of Ukraine in Vietnam at: 6 Le Hong Phong, Ba Dinh dist., Hanoi, Vietnam

All reports must be signed by parents.

We express our sincere appreciation to those parents, who adopted Ukrainian child (children) and hope to find understanding on the need to comply with the legislation of Ukraine and complete all post-adoption requirements in a timely manner.

 

 

 

 

 

Посольство України в Соціалістичній Республіці В’єтнам

6 Le Hong Phong, Ba Dinh dist., Hanoi, Vietnam

 

Громадянина (назва держави, П.І.Б.):

______________________________________

______________________________________

______________________________________

Громадянки (назва держави, П.І.Б.):

________________________________________

________________________________________

________________________________________

Дата народження:_______________________

Дата народження:________________________

Серія та номер паспортного документа ____

______________________________________

Серія та номер паспортного документа ______

________________________________________

Поштова адреса місця проживання ________________________________________________________________________________
________________________________________________________________________________
 
ЗАЯВА
 
Ми (П.І.Б. усиновлювачів), ____________________________________________________ 
________________________________________________________________________________,
які усиновили (П.І.Б. дитини, дата народження) _______________________________________
________________________________________________________________________________,
просимо взяти дитину на постійний консульський облік. 
 

Достовірність викладених у цій заяві відомостей підтверджуємо.

Нам роз’яснено, що у випадку зміни персональних даних дитини або місця її проживання необхідно своєчасно інформувати про це закордонну дипломатичну установу України, в якій дитина перебуває на постійному консульському обліку.  

 

Дата „____”____________ 20___ року      

Підпис_________________

Підпис_________________

Заповнюється консульською посадовою особою.

Заяву, облікову картку та документи, додані до них, прийняв.

 

_____________________

(назва посади)

_____________________

(підпис)

_______________________

(П.І.Б.)

 

„_____”______________20__ року      

           

 


 

 

 

ОБЛІКОВА КАРТКА

дитини-громадянина України, усиновленої іноземцями або громадянами України, які постійно проживають за кордоном

 

 

 

 

Місце для фотокартки

(35 х 45мм)

 
 

 

 

q  Прізвище, ім’я (після усиновлення)

________________________________________________________________________________________________________________________________________________________________

 

q  Прізвище, ім’я, по батькові (до усиновлення)

________________________________________________________________________________________________________________________________________________________________

 

q  Число, місяць і рік народження

________________________________________________________________________________

 

q  Місце народження

Країна:  _________________________________________________________________________

Субнаціональна адміністративно-територіальна одиниця (область/штат/провінція/земля/суб’єкт федерації/тощо):________________________________ ________________________________________________________________________________

Район: __________________________________________________________________________

Місто: __________________________________________________________________________

Село/селище: ____________________________________________________________________

 

q  Паспортний документ дитини (вказати назву) _____________________________________

 

Серія _________, № _______________

Орган, що видав _________________

Дата видачі ____________________

Дійсний до_____________________

 

q  Прізвища та імена усиновлювачів

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

q  Поштова адреса місця постійного проживання дитини за кордоном

Країна:__________________________________________________________________________ Субнаціональна адміністративно-територіальна одиниця (область/штат/провінція/земля/суб’єкт федерації/тощо):________________________________

________________________________________________________________________________

Район: __________________________________________________________________________

Місто:__________________________________________________________________________

Село/селище:____________________________________________________________________

Вулиця, будинок (квартира):_______________________________________________________

Поштовий індекс: ________________________________________________________________

 

 

q  Контактний телефон

___________________________

 

q  Електронна адреса

___________________________

 

 

q  Рішення суду про усиновлення дитини

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

Достовірність викладених у цій обліковій картці відомостей підтверджуємо.

 

 

Дата „____”____________ 20___ року                               Підпис_________________

                                                                                             

                                                                                              Підпис_________________

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