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Series БУКВИ УКРАЇНСЬКИМИ ЛІТЕРАМИ № ЦИФРАМИ

MINISTRY OF INTERNAL AFFAIRS OF UKRAINE 

DEPARTMENT OF INFORMATION TECHNOLOGIES

10 Bohomol'tsya str., Kyiv, 01601

CERTIFICATE

No.НОМЕР ДОВІДКИ ЦИФРАМИ 

On automatic records of the MIA the citizen of Ukraine ПРІЗВИЩЕ ІМ'Я ПО-БАТЬКОВІ, born on ДАТА НАРОДЖЕННЯ ЦИФРАМИ, native of МІСЦЕ НАРОДЖЕННЯ on the territory of Ukraine* as of ДАТА ВИДАЧІ ЦИФРАМИ has no criminal charges pending against him, no expunged criminal record and is not on wanted list.

This certificate is issued to be presented for МЕТА ВИДАЧІ ДОВІДКИ. 

Deputy Head of the Department           /signed/       ПРІЗВИЩЕ

Seal: Ministry of Internal Affairs of Ukraine, Department of information management and analysis, For reference

*According to the data of GUMVS of Ukraine in AR Crimea and UMVS of Ukraine in Sevastopol the information is given as of 27.03.2014.

The Certificate is issued on a free of charge basis (the Law of Ukraine “On the data privacy”, art. 19)

Using of blanks, seals by the police subdivisions…MVS of Ukraine (the Law of Ukraine “On the National police”, Chapter XI, art. 18)