Application for a U.S. Passport
WARNING: False statemen ts made kno wingly and willfully in passport applications, including affida vits or other documents sub mitted to sup por t
this application, are punishable by fine and/or imprisonment under U .S. law including the provisions of 18 U.S.C. 1001, 18 U .S.C. 1542, and/or 18
U.S.C. 1621. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the
provisions of 18 U.S.C. 1543. The use of a passport in violation of the restrictions contained herein or o f the passport regulations is punishable
by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents are subject to verification.
IMPORTANT NOTICE TO APPLICANTS WHO HAVE HAD A PREVIOUS U.S. PASSPORT BOOK AND/OR PASSPORT CARD
AS DIRECTED BY PUBLI C LAW 106-113 AND 22 CFR 51.28:
To submit an application for a child under age 16 both parents or the child's legal guardian(s) must appear
and present the fo llowing:
- Evidence of the child's U.S. citizenship;
- Evidence of the child's relationship to parents/guardian(s); AND
- Parental/guardian government-issued identification.
IF ONLY ONE PARENT APPEARS, YOU MUST ALSO SUBMIT ONE OF THE FOLLOWING:
- Second parent's notarized written statement or DS-3053 (including the child's full name and date of birth) consenting to the passport issuance for t he child.
The notarized statement cannot
be more than three months old and must be signed and notarized on the same day, and must come with a photocopy of
the front and back side of the second parent's government-issued photo identification; OR
- Second parent’s death certificate if second parent is deceased; OR
- Primary evidence of sole authority to apply; OR
- A written statement or DS-5525 (made under penalty of perjury) explaining in detail the second parent's unavailability.
AS DIRECTED BY REGULATION 22 C.F.R. 51.21 AND 51.28:
- Each minor child applying for a U.S. passport book and/or passport card must appear in person.
SPECIAL REQUIREMENTS FOR CHILDREN
FAILURE TO PROVIDE INFORMATION REQUESTED ON THIS FORM, INCLUDING YOUR SOCIAL SECURITY NUMBER,
MAY RESULT IN SIGNIFICANT PROCESSING DELAYS AND/OR THE DENIAL OF YOUR APPLICATION.
INFORMATION, QUESTIONS, AND INQUIRIES
U.S. PASSPORTS, EITHER IN BOOK OR CARD FORMAT, ARE ISSUED ONLY TO U.S. CITIZENS OR NON-CITIZEN NATIONALS. EACH PERSON
MUST OBTAIN HIS OR HER OWN U.S. PASSPORT BOOK OR U.S. PASSPORT CARD. THE PASSPORT CARD IS A U.S. PASSPORT ISSUED IN
CARD FORMAT. LIKE THE TRADITIONAL U.S. PASSPORT BOOK, IT REFLECTS THE BEARER'S ORIGIN, IDENTITY, AND NATIONALITY AND IS
SUBJECT TO EXISTING PASSPORT LAWS AND REGULATIONS. UNLIKE THE U.S. PASSPORT BOOK, THE U.S. PASSPORT CARD IS VALID
ONLY FOR ENTRY TO THE UNITED STATES AT LAND BORDER CROSSINGS AND SEA PORTS OF ENTRY WHEN TRAVELING FROM CANADA,
MEXICO, THE CARIBBEAN, AND BERMUDA. THE U.S. PASSPORT CARD IS NOT VALID FOR INTERNATIONAL AIR TRAVEL.
Please visit our website at travel.state.gov. In addition, you may contact the National Passport Information
Center (NPIC) toll-free at 1-877-487-2778 (TDD: 1-888-874-7793) or by email at [email protected]
. Customer
Service Representatives are available Monday-Friday 8:00a.m.-10:00p.m. Eastern Time (excluding federal
holidays). Automated information is available 24 hours a day, 7 days a week.
APPLICATION FOR A U.S. PASSPORT
PLEASE DETACH AND RETAIN THIS INSTRUCTIO N SHEET FOR YOUR RECORDS
I applied:
DS-11 09-2013
Place:
Date:
Instruction Page 1 of 4
WHAT TO SUBMIT WITH THIS FORM:
1. PROOF OF U.S. CITIZENSHIP (Evidence of U.S. citizenship that is not damaged, altered, or forged will be returned to you.)
2. PROOF OF IDENTITY (You must present your original identification AND submit a photocopy of the front and back side with your passport application.)
3. RECENT COLOR PHOTOGRAPH (Photograph must meet passport requirements – full front view of the face and 2x2 inches in size.)
4. FEES (Please visit our website at travel.state.gov
for current fees.)
WHERE TO SUBMIT THIS FORM:
Please complete and submit this application in person to one of the following acceptance agents: a clerk of a federal or state court of record or a judge or
clerk of a probate court accepting applications; a designated municipal or county official; a designated postal employee at an authorized post office; an agent
at a passport agency (by appointment only); or a U.S. consular offi cial at a U.S. Embassy or C onsulate, if abroad. To find your nearest acceptance facility,
visit travel.state.gov
or contact the National Passport Information Center at 1-877-487-2778.
LOST OR STOLEN - You are required to submit a Form DS-64, Statement Regarding a Lost or Stolen U.S. Passport, when your valid or potentially
valid U.S. passport book and/or passport card cannot be submitted with this application.
IN MY POSSESSION
- If your most recent U.S.passport book and/or passport card was issued less than 15 years ago, and you were over the age of
16 at the time of issuance, you may be eligible to use Form DS-82 to renew your passport by mail. If your most recent passport is valid and needs
additional pages, you can submit your passport, form DS-4085, and the current fee.
See page 2 of the instructions for detailed information on the completion and submission of this form.
APPLICATION FOR A U.S. PASSPORT
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