Passport Renewal Form

Name

First NameMiddle NameLast Name

Date of birth

Date

Place of birth

Gender

MaleFemale

Marital Status

Email

example@example.com

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Spouse Name

First NameMiddle NameLast Name

Father Name

First NameMiddle NameLast Name

Mother Name

First NameMiddle NameLast Name

Citizenship Acquired By

BirthElectionMarriageOther

Please Specify

Is this application for the replacement of a lost passport?

YesNo

Attach your related docs about your lost passport

Do you hold a passport issued by another country?

YesNo

Which country issued it?

I swear under oath that all of the information are truthful, complete and correct, and that all of my documents are authentic and valid. The information I provided in this application ara true and correct. The supoorting documents attached are authentic. I am aware that making false statements in passport application, furnished falsified or forged documents in support thereof are punishable by law.

Applicant’s Signature (Parent’s signature if Applicant is age 16 years or younger)