儿童寄养委托书 Power of Fosterage
委托寄养人,_______ ,男,系寄养儿童父亲。中国国籍,出生日期__________,护照号码:_________,现居住在___________________________________,电话:_____________
Principle, ________, Male, father of child______. Chinese, date of birth______________, Passport No. ____________, is currently reside in _____________________, Phone No. ______________
委托寄养人,_______ ,女,系寄养儿童母亲。中国国籍,出生日期__________,护照号码:_________,现居住在___________________________________,电话:_____________
Principle, ________, Female, mother of child_______. Chinese, date of birth_____________, Passport No. ___________, is currently reside in_______________________, Phone No. is _____________
承担寄养人,_______ ,男/女,系寄养儿童_______。中国国籍,出生日期__________,护照号码:_________,身份证号码:_________现居住在___________________________________,电话:_____________
Agent, __________, Male/Female, grandfather of child _______. Chinese, date of birth _________, Passport No. ___________, is currently reside in_________________________, Phone No. ______________
寄养儿童,_________,男/女,系委托寄养人的_____,承担寄养人的_______。新西兰国籍,出生日期__________,护照号码:_________
Fosterage child, ___________, Male/Female, the _________ of principle, the ________ of agent, was born in U.S. Date of birth ___________, Passport No. _______________
由于工作原因,我们夫妻双方自愿将 儿子/女儿 _____________ 送至中国,全权委托___________, 寄养儿童的________寄养,承担抚养与监护责任。寄养期限为______年(不超过五年)。受托人无转委托权。
We, both parents, voluntarily send child _________ to ___________ who is currently in China, agent_____ will held liability of child guardian. The fosterage period is ________ years (No more than 5 years). The power of attorney is non-transferrable.
委托人保留以书面或口头方式终止寄养的权利,并保证寄养儿童在期满后按时出境。
Principles reserve the right to terminate the power of fosterage in written or oral at any time, and promise the child will exit China prior to the fosterage expiration date.
委托人保证以上内容真实,如有不实之处,本人愿承担一切法律责任。
The foregoing is true and correct, and I assume full responsibility for the declaration.
委托人签字(Signature of Principle) ___________ 日期(Date): ___________
委托人签字(Signature of Principle) ___________ 日期(Date): ___________