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1. Date and Place of Execution: Current date and location where the letter is being executed
2. Guardian Information: Full legal name, ID number (KTP), address, and contact details of the legal guardian(s)
3. Child Information: Full legal name, place and date of birth, and other identifying information of the child
4. Basis of Guardianship: Statement explaining the legal basis of guardianship (e.g., court appointment, parent's death, etc.)
5. Purpose of Consent: Clear statement of the specific activities or decisions for which consent is being given
6. Duration of Consent: Specific timeframe for which the consent is valid
7. Guardian Declaration: Formal declaration of the guardian's sound mind and voluntary consent
8. Signature Block: Space for guardian's signature, witness signatures, and notary certification if required
1. Medical Consent: Additional section authorizing medical treatment decisions when the consent letter is intended for healthcare purposes
2. Travel Authorization: Specific details about authorized travel arrangements when the letter is for international or domestic travel purposes
3. Educational Decisions: Specific authorizations regarding educational decisions when the letter is for school-related purposes
4. Financial Authority: Details of any financial decisions or transactions the guardian is authorizing
5. Emergency Contacts: List of additional emergency contacts when needed for specific situations
6. Religious Considerations: Special religious requirements or considerations, particularly relevant for Muslim citizens under KHI
1. Copy of Guardian's ID: Certified copy of guardian's KTP (Indonesian ID card) or passport
2. Copy of Child's Birth Certificate: Certified copy of the child's birth certificate
3. Proof of Guardianship: Court order, death certificate of parents, or other official documents establishing guardianship
4. Witness Information: Copies of witness IDs and their contact information
5. Supporting Documents: Any additional relevant documents such as medical records, travel itineraries, or school enrollment forms depending on the purpose of the consent
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