Immigration Department Willemstad, Curacao Undersigned (full name)

To:
Immigration Department
Willemstad, Curacao
Undersigned (full name)
: _________________________________
Date of birth
: _________________________________
Hereby I give an authorization to Mr. Frank Saccomen/ Ms.Mireille Deira/
Mrs.Aurea Lodowica/ Mrs.Sherissa Marinus of the Avalon University School of
Medicine to submit/ collect/ change my documents for renewal/ application of
my Resident Permit/ Landing Permit/ Deposit Slip/ Re-Entry permit at
immigration department of Curacao.
Please note that he/she is not responsible for the accuracy of the documents that
I provide.
Place and date
: WILLEMSTAD-
Signature
: _____________________________________________