Third-Party Passport Authorization Form
Complete this form to authorize a third party to act on your behalf for passport-related matters. Please provide accurate information and review the authorization statement before submitting.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Third Party's Full Name
*
First Name
Last Name
Authorized Third Party's Email Address
*
example@example.com
Authorized Third Party's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Third Party
*
Please Select
Family Member
Friend
Legal Representative
Employer
Other
Purpose of Authorization
*
Please Select
Passport Application Submission
Passport Collection
Passport Renewal
Other Passport-Related Matters
Authorization Period (Start and End Date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Authorization Statement
I hereby authorize the above-named third party to act on my behalf for the purposes specified in this form, as related to passport matters. I confirm that the information provided is accurate and I accept responsibility for this authorization.
Signature
*
Submit Authorization
Submit Authorization
Should be Empty: