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U.S. Department of State STATEMENT OF CONSENT: ISSUANCE OF A U.S. PASSPORT TO A MINOR Underage 16USE OF THIS FORM The information collected on this form is used in conjunction with the DS11, “Application

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How to fill out statement of consent

01

Read the statement of consent form carefully.

02

Provide your personal information as requested in the form.

03

Understand the purpose and implications of the statement of consent.

04

Ensure that you agree with the terms and conditions stated in the form.

05

Sign and date the form to indicate your consent.

06

Submit the filled-out statement of consent to the relevant party or organization.

Who needs statement of consent?

01

Individuals who are participating in research studies or clinical trials.

02

Parents or legal guardians who need to provide consent on behalf of minors.

03

Patients who are undergoing medical procedures or treatments.

04

Individuals who are granting permission for the use of their personal information in certain circumstances.

05

Employees who are authorizing their employer to conduct background checks or gather certain information.

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What is statement of consent?

Statement of consent is a legal document where an individual gives permission for something to be done or for someone to act on their behalf.

Who is required to file statement of consent?

Individuals who want to authorize someone else to act on their behalf or make decisions for them may be required to file a statement of consent.

How to fill out statement of consent?

To fill out a statement of consent, one must provide their personal information, details of the authorized person, the specific actions or decisions being consented to, and sign the document.

What is the purpose of statement of consent?

The purpose of a statement of consent is to formally authorize someone else to act on an individual's behalf or make decisions on their behalf.

What information must be reported on statement of consent?

The statement of consent must include personal information of the individual giving consent, details of the authorized person, specific actions or decisions being consented to, and the signature of the individual giving consent.

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