Embassy 0f Ethiopia

PoA Registration Form

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Personal Information

First Name /In English/

Middle Name /in English/

Last Name /in English/

Sex

Date of Birth

Occupation

Place/Country of Birth

Current Nationality

Address in US

Home/Mailing Address

City

State

Zip/Postal Code

Contact Information

Day Tel.

Email

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Power of Attorney Information

Type of Power of Attorney

Method of Power of Attorney

Principals Info/የወካይ መረጃ

Full Name in Amharic/ ሙሉ ስም በአማርኛ

Nationality/ ዜግነት

Passport/ID Number

Street Name

City

State

Zip-code

Agent Info/የተወካይ መረጃ

ሙሉ ስም

Nationality/ ዜግነት

ክልል/ ከተማ፣

ዞን/ ክ/ከተማ

ወረዳ

የቤት ቁጥር

Agent Power/የውክልና ዝርዝር

የውክልናው ዝርዝር

Original Principal/ህጋዊ ወካይ መረጃ

Original Principal Name /ህጋዊ ወኪል አድራጊ ስም

PoA Number / የውክልና ስልጣን ቁጥር

Copy of Original PoA / ህጋዊ ውክልና ኮፒ

Ethiopian ID Information

Do You Have Ethiopian Passport or Origin ID?

Yes

No

If yes payment will be less.

ID Information

ID /Green Card/Driving License Number

Expired Date

ID /Green Card/Driving License Copy