U.S.Dep artm en t o f S tat e AP PL IC AT IO N F OR A U.S .PAS SP O RT Ins tr u ction Page 1 o f 4 DS-1 1 04-2 022 Please read al l in st ru ct io ns fir st a nd ty pe or pri nt i n b lack in k to c o m plet e th is fo rm .F or inf or mat ion or ques tions , v is it t r av el.s tat or c ont act t he Nat ion al P as spor t Inf or mation Cent er ( N PIC ) at 1-877 -487 -2778 (T DD/T TY : 1 -888 -874 -7793 ) or N PIC @ stat .SE C TIO N A .

E LIG IB IL IT Y T O U SE T H IS F O RM This form is used to apply for a U.S.passport book and/or card in person at an acceptance facility, a passport agency (by a ppointment only), or a U.S.embassy, c onsulate, or consular agency (if abroad).The U.S.passport is a travel document attesting t o one’s identity and issued to U.S.citizens or non-citizen U.


1S.nationals.To be eligible to use this form you must apply i n person if at least one of the following is true: I am appl ying for m y f ir st U .S .pas spor t  I am under age 16 My pr ev ious U .S .pas spor t w as ei ther : a) is sued under age 16; b) i ssu ed m or e than 15 year s ago ; c ) los t, s tol en, or dam aged • Notice to Applicants Under Age 16: You must appear in pers on to apply for a U.S.passport with your parent(s) or legal guardian(s).See Section D of thes e instructions or travel. for more details.• Notice to Applicants Ages 16 and 17: At least one of your parent(s) or legal guardian(s) must know that you are applying for a U.S.passport.See Section D of these instructions or for more details.• Notice to Applicants for No-F ee Regular, Service, Official, or Diplomatic Passports: You may use this application if you meet all provisions listed; however, you mus t consult your sponsoring agency for instructions on proper routing procedures before forwarding this application.Your completed passport will be released to your sponsoring agency and forwarded to you.

3SEC TIO N B .ST EPS TO A PPL Y FO R A U .S.PA SSP ORT 1.Com plet e thi s for m ( D o not s ign until r eque sted to do so by an author iz ed agent ).2.Att ac h one col or phot ograph 2×2 inc hes in siz e and supp orting doc ument s ( S ee S ection D of thes e ins tr uc tions ).3.Schedul e app oint ment to appl y in per son by v is it ing our w ebs it e or c al ling NPIC ( s ee c ont act inf o at the top page) .4.

4Arriv e for appoi ntment and pres ent c om plet ed for m and attac hm ent s t o the author iz ed agent w ho will adm ini ster t he oath, w it n ess y ou signi ng yo ur f or m, and col lec t y our pas spor t f ee.5.Trac k appl ic at ion stat us onl in e at P as spor ts tat us .s tat e.go v.6.Rec eive new pas spor t and origi nal s uppo rting doc ument s ( that y ou subm it t ed wit h your appl ic at io n) .SEC TIO N C .H O W T O C O M PL ET E TH IS FO RM Pleas e see th e ins tr uc tions bel ow f or it em s on the for m t ha t ar e not s el f- ex planat ory.T he num bers m atch the num bered it em s of the for m.

51.N am e (L ast , F ir st , M id d le) : E nt er t he name to appear in the pas spor t.T he nam e t o appear in the pas spor t s hou ld be cons is te nt w it h y our pr oof of c it iz ens hip and ident if ic at ion.If y ou hav e ch anged your nam e and are not el igi ble to us e a DS-82 or D S-5504, y ou mus t use thi s for m.V is it t r av el.s ta /nam echange f or m or e inf or mation.2.Date of Birth: Use the following format: Month, Date, and Year (MM/DD/YYYY).3.

6Gender: The gender markers used are “M” (male), “F” (female) and “X” (unspecified or another gender identity).The gender markerthat you check on this form will appear in your passport regardless of the gender marker(s) on y our previous passport and/or your supporting evidence of citizenship and identity.If changing your gender mark er from what was printed on your previous passport, select “Yes” in this field on Application Page 1.If no gender marker is selected, we may print the gender as listed on your supporting evidence or contact you for more information.Please Note: We cannot guarantee that other countries y ou visit or travel through will recognize the gen der marker on your passport.Visit for more information.4.Place of B ir th : E nt er the name of the cit y and stat e if in the U.

7S .or c it y and count ry as pr es ent ly k now n.5.Soci al S ecu rit y Num ber : Y ou mus t pr ov ide a Soc ial S ecur it y num ber ( S SN ), if y ou hav e been is s ued one, in ac cor danc e wit h Sec tion 6039E of t he Inter nal R evenue C ode ( 26 U.S .C .6039 E) and 22 U .S .C 2714a( f) .I f you do not have a S ocial S ecurit y num ber, you m ust ent er ze ros i n this f iel d and s ubmit a stat em ent, signed, and dat ed, that includes the phr ase, “I decl are under penal ty of per jur y under t he l aws of t he United S tat es of A mer ica th at t he f ollow in g i s true and c orrec t: I hav e never been i ssued a S ocia l S ecurit y N umber by the Social Security Administration.

8” If you reside a broad, you must also provide the name of the foreign country where you res ide.The U.S.Department of State must provide your SSN and foreign residence information to the U.S.Department of the Treasury which will use it in connection with debt collection and check against lists of persons ineligible or potentially ineligible t o receive a U.S.passport, am ong ot her aut horized use s.If yo u fail to pr ovide t he infor mation, w e may deny yo ur appl ic at ion a nd the Inter nal R evenue S ervic e ( IR S) m ay enf orce a penal ty .R efer al l que stions on t his m atter t o the near est IRS of fic e.

96.Email: By providing your email you are consenting to us communicating with you by email about your application.7.P ri ma ry C ont ac t P hone N umbe r: If pr ov idi ng a m obi le/ cel l phone number you are consenting to receive calls and/or text messaging about your application.8.M ai li n g A dd ress Lin e 1 an d 2 “In C ar e Of” : F or line 1 ent er appl ic a nt ’s S tr eet /R FD #, or P .O .B ox or UR B.F or lin e 2 , if y ou do not live at the address listed in this field, p ut the name of the person who lives at this address and mark it “In Care Of”.If the applicant is a minor child, you must include the “I n Care Of” name of the parent or adult registered to recei ve mail at this address.

109.List al l o th er n am es you h ave used : E nt er al l legal na mes pr ev ious ly us ed to inc lu de maiden name, nam e changes , and prev ious married names.You can enter up to two names one in item A and one in item B.If only your last name has changed just enter your last name.If you need more space to write additional names , please use a separate sheet of paper and attach it to this form.OMB Control No.1 405-0004 Expira tion Date: 04-30-2025 Estimated B urden: 85 Minutes U.S.Dep artm en t o f S tat e AP PL IC AT IO N F OR A U.S .

11PAS SP O RT Ins tr u ction Page 2 o f 4 DS-1 1 04-2 022 SECTIO N D .A TT A CH M EN TS TO SU BM IT W IT H T H IS FO RM Onc e you hav e com plet ed Appl ic at ion P ages 1 and 2, at tac h the suppo rting doc ument s as out lined in thi s s ec tion.1.PR O O F O F U .S .C IT IZ E N SH IP I nf or mat io n can be foun d on tr av el.s tat /c it iz ens hip.App li can ts B orn O utsi de th e Unit ed S tat es Applicants Born in the United States Your evidence will be returned to you if it is not damaged, altered, or forged.Submit an original or certified copy and a p hotocopy of the front and back if there is printed information on the back, of one of the following doc uments : • U.

12S.Birth Certificate t hat meets all the following requirements: o Issued by the city, county, or state of birth o Lists your full name, birthdate, and birthplace o Lists your parent(s)’ full names o Lists date fil ed with registrar’s office (must be within one year of birth) o Shows registrar’s signature and the s eal of the issuing authority • Fully valid, u ndamaged U.S.passport (may be expired) • Consular Report of Birth Abr oad or Certification of Birth Abroad • Certificate of Naturalization or Citizenship • Secondary doc uments may be submitted if the U.S.birth certificate was filed more than one y ear after your birth or if no birth record exists.For no birth record on file, submit a registrar’s letter to that e ffect.For both scenarios, s ubmit a combination of the evidenc e listed below, with your first and last name, birthdate and/or birthplace, the seal or other certification of the office (if customary), and the signature of the issuing official.o A hospital birt h record o An early baptismal or c ircumcision certificate o Early census, school, medical, or family Bible records o Insurance files or published birth announcements (such as a newspaper article) o Notariz ed affidavits (or DS-10, Birth Affidavit) of o lder blood relatives having knowledge of your birth may be submitted in addition to some of the records listed above.I f w e det ermine that y ou are a U.

13S .c it iz en, y our law ful pe rm anent res ident c ar d subm it ted wit h t hi s appl ic at io n will be for warded to U .S .C it iz ens hip and Im migr ation Servi ce s.• Clai m ing Cit iz ens hip thr ough Nat ur aliz at io n of O ne or B ot h Par ent (s ), s ubm it al l the fol lo w ing: o Your par ent(s ) C er tif ic at e( s) of N at ur aliz at ion o Your par ents’ m ar riage/ cer tif ic at e and/ or ev idenc e that y ou w er e in the le gal and physic al c us tody of y our U .S .c it iz e n par ent, if appl ic abl e o Your for eign bir th cer tif ic at e (and offic ial tr ans lat ion if the doc ument is n ot in Engl is h) o Your ev idenc e of adm is sion to the Uni ted Stat es for legal per manent r es idenc e and proof y ou subs equent ly r es ide d i n the Unit ed S tat es • Clai m ing Cit iz ens hip thr ough Bir th Abr oad to At Leas t O ne U.S .C it iz en P arent , s ubm it al l the fol low ing: o Your C ons ular R epor t of B ir th Abr oad (F or m F S -240) , C er tif ic at ion of B ir th (F or m D S-1350 or F S -545) , or y our f or eign birth c ertif ic at e (and offic ial t r ans lat ion if the doc ument is n ot in Engl is h) o Your par ent’s pr oof of U .S .

14c it iz ens hip o Your par ents’ m ar riage cer tif ic at e o Affidav it s ho wing all y our U .S .c it iz en par ent s’ per iods a nd pl ac es of r es id enc e and physic al pr es enc e bef ore your bi rth (D S-550 7) • Clai m ing Cit iz ens hip Thr ough Adopt ion by a U.S .C it iz en P ar ent (s ), if y our bi rthdat e is on or af ter O ctober 5, 1978, s ubm it ev iden ce of al l t he fol low ing: o Your per manent r es idenc e stat us o Your ful l and final adopt ion o You wer e in th e legal and physic al c us tod y of y our U .S .c it iz en par ent(s ) o You hav e res ided in the Uni ted Stat es 2.PROOF OF IDENTITY Information can be found at

15Present your original identification and submit a front and back photocopy wit h this form.It must show a photograph that is a good likeness of you.Examples include: • Driv er ‘s lic ens e (not t em por ary or lear ner ‘s per mit ) • Prev ious or c u rrent U .S .pas spor t book /c ar d • Milit ar y ident if ic at ion • Feder al, s tat e, or c it y gov ernm ent em ploy ee ident if ic at ion • Cer tif ic at e of N at ur aliz at ion or C it iz ens hip 3.A RECENT COLOR PHOTOGRAPH See the full list of photo requirements on trav one photo, 2×2 inc hes in size.U.

16S.pas sport photo requirements may differ from photo requirements of other countries.To avoid processing delays, be sure your photo meets all the following requirements (Refer to the photo template on Application Page 1): • Tak en les s th an six m ont hs ago • Head mus t be 1 -1 3/8 inc hes fr om the bottom of the c hi n to the top of t he head • Head mus t fac e the cam era direc tly w it h fu ll fac e in vie w • No ey egl asse s and head co ver ing and no unifor ms* • Print ed on matte or gl os sy p hot o qual it y p aper • Use a plain whi te or of f- w hi te bac kgr ound *H ead cov erings ar e not ac cept able unl ess y ou subm it a signed stat em ent v er if y ing that it is par t of r ec ogni zed, tr adi tional r el igi ous at tir e that is c us tom aril y or r equi red to be wor n cont inuous ly in publ ic or a sig ned doctor ‘s s tat em ent v er if y ing it s dai ly u se for m edi cal pur pos es.G las ses or ot her ey ew ear are not ac cept abl e unl ess y ou s ubm it a sign ed stat em ent fr om a doc tor ex plaining why y ou cannot r em ove them ( e.g., dur ing the rec overy per iod fr om ey e sur ger y).P hot os ar e to be tak en in clot hing nor mally w or n on a dai ly bas is .Y ou cannot w ear a unifor m, c lot hing that look s li k e a uni for m, or c am ouf lage attir e.U.S.

17Dep artm en t o f S tat e AP PL IC AT IO N F OR A U.S .PAS SP O RT Ins tr u ction Page 3 o f 4 DS-1 1 04-2 022 4.PRO OF O F P AR EN TA L RE LAT IO NS HIP ( F O R APPLICA NTS U NDE R AG E 1 6) P ar ent s/guar dians m us t app ear in per son wit h the chi ld and subm it th e fol low ing: • Evidence of t he child’s relationship to parents/guardian(s) (Ex ample: a birth certificate or Consular Report of Birth Abroad listing the names of the parent(s)/guardian(s ) and child) •Origi nal par ental/guar dian gov ernm ent-is sued phot o ide ntif ic at ion and a phot ocopy o f the fr ont and back ( to sat is fy pr oof of ident it y ) If onl y one parent/guar dian can appear in per son wit h the c hi ld , y ou must al so subm it one of t he fol low ing: • The sec ond parent’s not ariz ed writ t en stat em ent or D S-3053 (inc ludi ng the chi ld’ s fu ll nam e and dat e of bi rth) c ons enting to th e pas spor t is sua nce for t he chi ld.T he notariz ed stat em ent c annot be mor e than thr ee mont hs ol d, m ust be signed and notariz ed on the s am e day , an d m us t c om e wit h a fr ont and back phot ocopy of the sec ond parent’s g ov ernm ent-is sued phot o ide ntif ic at ion.• The sec ond parent’s deat h cer tif ic at e (if s ec ond parent is dec eased) • Evidenc e of s ol e aut hor it y t o appl y ( E xam ple: a cour t or der gr ant ing sol e legal c us to dy or a birth cer tif ic at e lis tin g onl y one parent) • A w rit ten stat em ent ( m ade under penal ty of per jur y) or D S-5525 ex plai ning, in detai l, w hy t he sec on d par ent c annot be reac hed OR PRO OF O F P ARE NTA L AWA REN ES S (FO R AP PLIC ANT S AG ES 1 6 A ND 17) W e may r eques t the cons ent of one legal par ent/legal guar dian to is s ue a U.S .pas spor t to you.I n many c as es, the pas spor t aut hor iz ing of fic er m ay be able to as cer tai n par ental aw arenes s of t he appl ic at ion by v ir tue of the par ent’s pr es enc e when th e m inor s ubm it s the appl ic at ion or a signed note fr om t he par ent or pr oof the par ent is pay ing the appl ic a tion fees .H ow ev er, the passpor t aut hor iz ing offic er r et ains di scret ion to reques t the legal par ent’s /legal guar dian’ s not ariz ed s tat em ent of c ons ent to is s uanc e (e.

18g., on For m D S-3053) .5.FEES Passport service fees are established by law and regulation (see 22 U.S.C.214, 22 C.F.R.22.

191, and 22 C.F.R.51.50-5 6) and are collected at the time you apply for the passport service.By law, the passport fees are non-r efundable.Visit passportfees f or current fees a nd how fees are used and proc essed.Payment methods are as follows: App li can t A pp lyi ng in t h e Unit ed S tat es At A ccep tan ce Faci lit y A pp li can t A pp lyi ng at a Passp ort A gen cy or O utsi de th e Unit ed S tat es • Pas spor t fees m us t be made by c hec k ( per sonal , c er tif ied , cas hier ’s, t r av eler s) or m oney or der ( U .

20S .P os tal , int er na tional , c ur renc y ex ch ange) w it h the appl ic ant ‘s ful l nam e and date of bi rth pr int ed on the fr ont and payable to “U .S .D epar tm en t of S tat e.” • The execution f ee must b e pai d sep arately and made payable to the accept anc e fac ilit y in the for m t hat they ac cept .• We ac cept c h ec ks ( per sonal , c er tif ied, c as hier ’s , t r av eler s); m ajor c redi t c ar ds ( V is a, M aster C ar d, A m er ic an Expr es s, D is cov er); m oney or der s ( U .S .P os ta l, int ernat ional , c ur renc y ex change) ; or ex act c as h (n o change prov ided) .M ak e all f ees pay able to the ” U .S .

21D epar tm ent of S tat e.” • If applying outside the United States: Please see t he website of your embassy, consulate, o r consula r agency for acceptable payment methods.O th er S er vices Req uir in g A ddit io nal F ee (V is it t r av el.s tat for m or e det ails ): • Expedite Service: Only available for passports mail ed in the United States and Canada.• 1-2 Day Delivery: Only available for pas sport book (and not passport c ard) mailings in the United States.• Verification of a previous U.S.Passport or Consular Report of Birth Abroad: Upon your request, we verify previously issued U.S.

22passport or Consular Report of Birth Abro ad if you are unable to submit evidence of U.S.citizenship.• Special Issuan ce Passports: If you apply for a no-f ee regular, service, official, or diplomatic pas sport at a designated acceptance facility, you must pay the execution fee.No other fees are charged when you apply.SECTIO N E.H O W T O SU BM IT T H IS FO RM Subm it t ing y o ur f or m depends on your loc ation and how s oon you nee d your pas spo rt.• App li can t L ocat ed I n si de th e Unit ed S tat es: For the la tes t inf or mation regar ding proc essing tim es, s chedul ing appoi ntm ent s, and near est des ig nat ed accept anc e fac ilit ies v is it t r av el.s tat or c ont act N PIC .

23• Appli can t L ocat ed O utsi de th e Unit ed S tat es: I n mos t c ount ries , y ou mus t appl y in per son at a U.S .em bas sy or c ons ulat e for al l pas spor t s er vic es .E ac h U.S .em bas sy an d cons ulat e has di ff er ent pr oc edur es f or s ubm it ting and proc essing yo ur appl ic at ion.V is it t r av el.s tat to chec k the U.S .

24em bas sy or c ons ulat e webpage for m or e inf or mation.SEC TIO N F .R EC EIVING YO UR P A SSPO RT A ND SU PPO RTIN G D O CUM EN TS • Difference Between U.S.Passport Book and Card: The book is valid for international travel by air, land, and sea.The card is not valid for international air travel, only for entry at l and border crossings and seaports of entry when traveling from Canada, Mexico, Bermuda, and the Caribbean.The maximum number of letters provided for your given name (first and middle) on the card is 24 characters.If both your given names are more than 24 charac ters, you must shorten one of your given names you list on item #1 of Application Page 1.• Separate mailings: You may receive your newly issued U.S.

25passport book and/or card and your citizenship evidence in two separate mailings.If you are applying for both a book and card, you may receive thr ee separate mailings: one with your returned evidence, one with your newly issued b ook, and one with your newly issued card.All d ocumentary e vidence that is not d amaged, a ltered, or forged w ill be returned t o you.Photocopies w ill not b e returned.• Passport numbers: E ach newly issued passport book or car d will have a different passport number than your previous one.• Shipping and Delivery Changes: If your mailing address changes prior to receipt of your new passport, please contact NPIC.NOTE: We will not mail a U.S.passport to a priv ate address outside the United States or Canada.• Passport Corrections, Non-R eceipt/Undeliverable Passports, and Lost/Stolen Passport: For more information visit travel. or contact NPIC.U.S.Dep artm en t o f S tat e AP PL IC AT IO N F OR A U.S .PAS SP O RT Ins tr u ction Page 4 o f 4 DS-1 1 04-2 022 WARN IN G Fal se stat em ents m ade kno wingl y and will f ul ly in pas spo rt appl ic at ions , inc ludi ng affid av it s or ot her doc uments s u bm it ted to suppor t thi s appl ic at ion, ar e puni shabl e by f ine and/ or im pr is onm ent under U .S .la w inc ludi ng th e pr ov is ions of 18 U.S .

27C .10 01, 18 U.S .C .1542, and/ or 18 U.S .C .162 1.A lt er ation or m ut ilat ion of a pas spor t is s ued pursuant t o thi s appl ic at ion is puni shab le by fine and/ or im pr is onm ent under t he prov is ions of 18 U.S .

C .1 543.T he use of a pas spor t in viol at ion of t he res tr ic tions c ont ained herein or of pas spor t r egul ations is puni shabl e by fine and/ or im pr is onm….


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