Fillable STATEMENT Who is an agent for VISA SUPPLY

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STATEMENT Who is an agent for VISA SUPPLY

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STATEMENT
I, ______________________________________, authorize Mr. / Ms. __________________________________
(Visa Applicant Name) (VISA SUPPLY Agent name)
Who is an agent for VISA SUPPLY LLC, to apply for a visa and pick up my passport with the visa at the Consulate
General of Japan.
Signed by: ______________________________________________
(Visa Applicant Signature)
Date: ____________________________
If the applicant is a minor (under the age of 18 years old), the parent(s) must sign the above statement and add
the child name below, a copy of the parent(s) passport(s) and the birth certificate of the minor.
_____________________________________
(Name of the minor)
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STATEMENT Who is an agent for VISA SUPPLY

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Completed 14 March 2022

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