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U.S. Department of State STATEMENT OF CONSENT: ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16 USE OF THIS FORM The information collected on this form is used in conjunction with the DS11, “Application
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Read the statement of consent carefully to understand the requirements and purpose.
02
Provide your personal information such as name, address, date of birth, and contact details.
03
Include the details of the person or organization you are giving consent to.
04
Specify the purpose for which you are granting consent.
05
Clearly state the duration or validity period of the consent.
06
Sign and date the statement of consent.
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If required, have the statement of consent notarized or witnessed by a third party.
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Keep a copy of the statement of consent for your records.

Who needs statement of consent?

01
Individuals who are required to give their consent for a specific purpose.
02
Parents or legal guardians providing consent on behalf of a minor.
03
Participants in research studies or clinical trials.
04
Individuals participating in activities that involve potential risks or legal obligations.
05
Companies or organizations collecting personal information or data from individuals.
06
Parties involved in legal agreements or contracts where consent is necessary.
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Statement of consent is a formal document where an individual willingly gives permission or approval for a specific action or decision.
Individuals or entities who are directly involved in the action or decision requiring consent are required to file statement of consent.
Statement of consent can be filled out by providing personal information, details of the action or decision requiring consent, and a signature indicating approval.
The purpose of statement of consent is to ensure that all parties involved are aware of and agree to the specific action or decision being made.
Information that must be reported on statement of consent includes personal details of the individual giving consent, details of the action or decision, and date of approval.
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