I,..................................................................................................................................................................., residing at ......................................................................................................................................................................................................................... City.............................................................., State...............................................................Zip Code .......................U.S.A. is a natural parent (father/mother) of ...................................................................................................................
I do hereby give my permission to my child whose name is ........................................ ...........................................................................................................................................................................................................................
to travel abroad, and allow .....................................................................................................................who is my ..............................................................., apply for a Thai passport for my child and sign a liability agreement with the Ministry of Foreign Affairs.