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We, Azin Boris Borisovich, born in 06.09.1971,passport AN2829391, issuing authority MKK
50-00, date of issue 09.04.2012,residing in gorod Karakol, ulitsa Amanbaeva 104 and Azina
Elena Borisovna, born in 17.10.1975,passport AN2829392, date of issue 09.04.2012, residing in
gorod Karakol, ulitsa Asanalieva 3, the farther and mother of Azina Daria, born in 07.06.1975
passport AC 1732113,issuing authority SRS, date of issue 13.09.2011 residing in gorod Karakol
ulitsa Asanalieva 3, give our consent for her travel to U.S. without our accompaniment for the
period one year, from 15 July 2012 to 15 July 2013, in order to participate in the Secondary
School Program, administrated by American Councils for International Education.

Signatures:

____________ Azin Boris Borisovich

____________ Azina Elena Borisovna

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  • 1. We, Azin Boris Borisovich, born in 06.09.1971,passport AN2829391, issuing authority MKK 50-00, date of issue 09.04.2012,residing in gorod Karakol, ulitsa Amanbaeva 104 and Azina Elena Borisovna, born in 17.10.1975,passport AN2829392, date of issue 09.04.2012, residing in gorod Karakol, ulitsa Asanalieva 3, the farther and mother of Azina Daria, born in 07.06.1975 passport AC 1732113,issuing authority SRS, date of issue 13.09.2011 residing in gorod Karakol ulitsa Asanalieva 3, give our consent for her travel to U.S. without our accompaniment for the period one year, from 15 July 2012 to 15 July 2013, in order to participate in the Secondary School Program, administrated by American Councils for International Education. Signatures: ____________ Azin Boris Borisovich ____________ Azina Elena Borisovna