Contact Information

Where should the passport be mailed?

Note: Please complete this section with a mailing address even if you are picking up your new passport directly from a passport agency.

Preferred Method of Communication

Your Email Address

Your Phone Number

Additional Phone Number

Travel Plans

Please complete this section with known or anticipated travel plans.

Note: If you are traveling within two weeks, do not mail in your passport application. If you do, your application may not be completed before your travel date. Please call the National Passport Information Center at 1-877-487-2778 (TDD: 1-888-874-7793) to make an appointment to appear in person at a Passport Agency and receive expedited processing. The automated appointment system is available twenty-four hours a day, seven days a week

Who should we contact in case of an emergency?

Your Most Recent Passport

Lost Or Stolen Passport Information

MINORS - If you are reporting a lost or stolen passport for a minor (persons under the age of 16), a parent or guardian must sign and mail-in a paper DS-64 Statement Regarding Lost or Stolen Passport.

I, the undersigned, declare under penalty of perjury all of the following: 1) That I have read and understood the warning on page one of this form; 2) The information furnished herein is correct and complete; 3) I have not given my U.S. passport book and/or passport card to another person or disposed of it in an unauthorized manner; 4) I understand that the U.S. passport(s) I report as missing will be invalidated and cannot be used; and 5) if I subsequently find and recover it, I will immediately return the passport and/or passport card to Passport Services at the address on page one of this form or to the nearest U.S. passport agency, U.S. embassy, or U.S. consulate abroad.

Applicant's Parent & Spouse Information

Note: Please fill in as much information as you know. If completing as a third party or parent of minor, complete the form in the context of the applicant not yourself.

Mother/Father/Parent Of Applicant      Unknown

Mother/Father/Parent Of Applicant      Unknown

Spouse Of Applicant

Personal Application Review

Review the data below and make edits if needed

Name Provided:

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Date Of Birth:

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Place Of Birth:

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Social Security Number:

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Sex:

Male

Female

Height:

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Hair Color:

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Eye Color:

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Occupation:

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Employer:

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Mailing Street Address:

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Mailing Street Address 2:

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City:

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State:

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Zip Code:

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Country:

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Permanent Address Same As Mailing Address:

No

Yes

Permanent Street Address:

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Apartment Number:

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City:

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State:

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Zip Code:

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Country:

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Email Address:

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Home Phone:

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Date Of Trip:

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Return Date from Trip:

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Countries To Be Visited:

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Emergency Contact:

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Relationship:

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Street Address :

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Apartment Number:

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City:

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State:

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Zip Code:

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Contact Phone:

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Have Passport Book:

Yes

No

Name On Previous Passport Book:

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Previous Passport Book Number:

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Book Issuance Date:

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Book Still In Possession:

Yes

No

Have Passport Card:

Yes

No

Name On Previous Passport Card:

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Previous Passport Card Number:

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Card Issuance Date:

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Card Still In Possession:

Yes

No

Reason For Name Change:

Marriage

Court

Date Of Name Change:

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Place Of Name Change:

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Name Of Mother/Father/Parent:

Unknown

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Mother/Father/Parent Date Of Birth:

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Mother/Father/Parent Place Of Birth:

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Mother/Father/Parent Sex:

Male

Female

Mother/Father/Parent U.S. Citizen:

Yes

No

Name Of Mother/Father/Parent:

Unknown

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Mother/Father/Parent Date Of Birth:

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Mother/Father/Parent Place Of Birth:

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Mother/Father/Parent Sex:

Male

Female

Mother/Father/Parent U.S. Citizen:

Yes

No

Married:

Yes

No

Name Of Spouse:

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Spouse Date Of Birth:

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Spouse Place Of Birth:

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Spouse U.S. Citizen:

Yes

Date Of Most Recent Marriage:

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Widowed or Divorced:

Yes

No

Widowed or Divorced Date:

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