Suggested Notarisation Form for Adoption [R. of I.].

Thai Adoption Group
Ireland

[NOTE:    Make an appointment with a Notary Public in advance.   Check the charge for having 3 bound booklets notarised.   Having done so,   prepare 3 completed copies of the form set out below inserting at the points indicated the relevant information re names,   locations,  etc..    (When prepared and completed by you,   the form should be such that the Notary only needs to read it,  date it, sign it and attach his seal).   Attach one form to the front page of each bound booklet]

In Respect of:- The Adoption Application of:-

both of:-                 ,                    , County             , in the Republic of Ireland.

Signatures:-                                                                                                

                                    Mr. [type name]                        Ms.  [type name]

TO ALL TO WHOM THESE PRESENTS SHALL COME:-

I                                         , of                                          in the County of                 , Republic of Ireland, Notary Public duly authorised, admitted and sworn and practising at                         , County                  in the Republic of Ireland

DO HEREBY CERTIFY that on the at                             , County of Offaly, Republic of Ireland, before me personally came the above named  Mr.                        and Ms.                         (previously             ) to me known and in my presence duly signed the bound, booklet of documents hereto annexed and now marked by me for the purposes of identification described as "Application for Adoption of Mr.                & Ms.                     (formerly             )"

AND I DO FURTHER CERTIFY that the name and signature of Mr.                     and Ms.                         signed to the said booklet as the same now appears constitute the true and proper name and signature of Mr.                &  Ms.                    .

AND I DO FURTHER CERTIFY that prior to the signing of their respective names aforesaid,    Mr.                & Ms.                     (formerly                 ) stated that such documents as comprised a statement of their financial assets, affairs and circumstances were a true and accurate statement of such.

AND I DO FURTHER CERTIFY that where such documents as are contained within the annexed, bound bundle are photographic copies, that such are a true and faithful copy in words and figures of the original documents now to me produced, fair and uncancelled which after careful examination I attest.

IN TESTIMONY WHEREOF, I have here unto subscribed my name and affixed my seal at                  County of             , Republic of Ireland on this         day of                         in the year 2000.