APPLICATION FORM FOR TRINIDAD AND TOBAGO PASSPORT

APPLICATION FORM FOR TRINIDAD AND TOBAGO PASSPORT
(APPLICANTS 16 YEARS AND OVER)
WARNING TO ALL APPLICANTS AND RECOMMENDERS
PLEASE PRINT INFORMATION IN BLOCK LETTERS
USING DARK BLUE OR BLACK INK PEN
Any such person who makes a written or oral statement knowingly to be false
or misleading is guilty of an offence and is liable to fine and imprisonment.
FOR OFFICIAL USE ONLY
PASSPORT
TYPE
EXPEDITED
PRE-PAID
SHIPPING
_________
ORIGIN
_____________
RECEIPT #
_______________ PASSPORT #
__________________
PICK UP
_____________
DATE
_______________ DATE OF ISSUE
_________________
REASON FOR
APPLICATION
_____________
_________
____________
VALID TO
_________________
1.
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
MIDDLE NAME(S) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
MAIDEN NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
FORMER NAME
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
MOTHER’S MAIDEN NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
DO NOT BEND OR FOLD
FATHER’S FULL NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
2. PERSONAL INFORMATION
_______/_______/_______
DATE OF BIRTH
Day
PLACE OF BIRTH
Month
SEX
MALE [
]
FEMALE
[
]
PHOTOGRAPH
Year
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
TOWN /CITY
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
COUNTRY
HEIGHT (CM)
____________
HAIR COLOUR
/___/___/___/___/___/___/___/___/___/___/
MARITAL STATUS: SINGLE
[ ]
SEPARATED [ ]
OCCUPATION / PROFESSION
COLOUR OF EYES
MARRIED [
]
OTHER
]
[
/___/___/___/___/___/___/___/___/___/___/
WIDOWED [ ]
DIVORCED [
]
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
HOME ADDRESS
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Street Name
Town/ City
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Town /City
Zip Code
Country
MAILING ADDRESS (IF DIFFERENT FROM HOME ADDRESS)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Street Name
Town/ City
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Town /City
Zip Code
Country
WORK ADDRESS, OR IF RESIDENT ABROAD, LOCAL ADDRESS
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Street Name
Town/ City
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Town /City
Zip Code
Country
NAME OF FIRM / ORGANIZATION
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
HOME TEL. NO.
/___/___/___/___/___/___/___/___/___/___/___/
MOBILE NO.
/___/___/___/___/___/___/___/___/___/___/___/
OFFICE TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/
E-MAIL ADDRESS ___________________________________________
(*N.B. * This form will become void if the Specimen Signature touches the Border)
Specimen Signature of Applicant
MARRIED WOMEN
PRESENT MARRIAGE
______/_______/_______
DATE OF MARRIAGE
Day
Month
PLACE OF MARRIAGE _________________________________________
Year
HUSBAND ‘S NAME
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
NATIONALITY
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
PREVIOUS MARRIAGE (S)
Date of Marriage (Date/Month/Year)
Husband’s Name in Full
Place of Marriage
Husband’s Nationality
3. PERMISSION FROM PARENT / LEGAL GUARDIAN FOR APPLICANTS UNDER 18 YEARS OF AGE
I, FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Solemnly declare that I am the
_________________________________________
of the Applicant, and hereby give permission to
(RELATIONSHIP)
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
To apply for a Trinidad and Tobago Passport.
Dated
__________/__________/__________
Day
Month
Year
I.D./ Passport # of
Parent /Legal Guardian
_______________________________
Date of Issue
__________/__________/__________
Day
4. DECLARATION OF RECOMMENDER
Month
Signature of Parent/ legal Guardian
Year
* (To be completed by the Recommender Only) *
I, FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Solemnly declare that I am a citizen of Trinidad and Tobago and to the best of my
knowledge and belief, all statements made in this application form are true. I make
this declaration from my knowledge of the applicant whose name is:
OFFICIAL STAMP OF
FIRM / ORGANIZATION
NAME OF APPLICANT
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Whom I have known personally for …………………………………………… years and whose photograph I have certified on the reversed side (applicable
to renewals only).
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
MY OCCUPATION
NAME OF FIRM / ORGANIZATION AND ADDRESS
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Name of Firm / Organization
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Street Name
Town/ City
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
Town /City
Zip Code
OFFICE TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/ HOME TEL. NO.
Dated _______/_________/________
Day
Month
Country
/___/___/___/___/___/___/___/___/___/___/___/
I.D./ D.P. / PASSPORT # _______________________________
Year
Date of Issue
_______/_________/________
Day
Month
Year
Date of Expiry _______/_________/________
Day
Signature of
Recommender
Month
Year
5. CITIZEN OF TRINIDAD AND TOBAGO BY:
(A)
BIRTH
PIN NO.
[ ]
_______________________________________
REGISTRATION DATE
_______/_________/________
Day
(B)
DESCENT
Month
CERTIFICATE NO.
_________________________________________
REGISTRATION DISTRICT
____________________________________
Year
[ ]
CERTIFICATE NO. ___________________________
ISSUE DATE
_______/_________/__________
Day
(C)
ADOPTION
CERTIFICATE NO. ___________________________
ISSUE DATE
Year
_______/_________/__________
Day
(D)
Month
[ ]
REGISTRATION [ ] / NATURALISATION [
Month
CERTIFICATE NO. __________________________
ISSUE DATE
_______/_________/__________
Day
Month
ARE YOU NOW OR HAVE YOU EVER BEEN A CITIZEN OF ANY COUNTRY OTHER THAN TRINIDAD AND TOBAGO? YES [
If yes, please provide details below
COUNTRY
Year
]
CITIZENSHIP BY
CERTIFICATE NO.
Year
] NO [
]
ISSUE DATE (Date/Month/Year)
1.
2.
3.
6. TRINIDAD AND TOBAGO PASSPORT(S) PREVIOUSLY
Have you applied for or been issued any Trinidad and Tobago Passport(s) or other Trinidad and Tobago travel Documents?
PASSPORT NO.
DATE OF ISSUE (Date/Month/Year)
YES [ ] NO [
]
PLACE OF ISSUE
If YES, list in the Table provided and
submit most recently issued document
7. ADDITIONAL REFERENCES
Please provide the following information with respect to two persons who are not relatives and have known you for at least three years.
These persons may be contacted to confirm your identity.
(i)
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
HOME ADDRESS or BUSINESS ADDRESS (IN FULL)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
TEL. CONTACT
/___/___/___/___/___/___/___/___/___/___/___/
(ii)
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
HOME ADDRESS or BUSINESS ADDRESS (IN FULL)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
TEL. CONTACT
/___/___/___/___/___/___/___/___/___/___/___/
8. DECLARATION OF APPLICANT
I ____________________________________________________________________________________ solemnly declare that :
(i)
(ii)
(iii)
(iv)
(v)
(vi)
I am a Trinidad and Tobago citizen.
The statements made in this application are true.
The photographs enclosed are a true likeness of me.
I do not have a Trinidad and Tobago Passport other than the one(s) listed at section 6.
I know the recommender for at least three years; and
I shall report to the Passport Office or the nearest Trinidad and Tobago Government Office any change in citizenship.
DATED
________/________/____________
I.D. / PASSPORT #
_____________________________
DATE OF ISSUE
________/________/____________
Day
Day
Month
Month
Year
Year
Signature
FOR OFFICIAL USE ONLY
PREQUALIFICATION OFFICER
______________________________________
DATE
_______/_________/________
Day
BIRTH CERTIFICATE INFORMATION
COMPUTER GENERATED CERTIFICATE
Year
[ ]
PIN NO._______________________________________
REGISTRATION DISTRICT
Month
CERTIFICATE NO.____________________________________
________________________________________
REGISTRATION DATE _______/_________/________
Day
Month
Year
ENTRY NO._________________________
MANUAL CERTIFICATE
[
]
CERTIFICATE NO.____________________________________
REGISTRATION DISTRICT
________________________________________
REGISTRATION DATE _______/_________/________
Day
ENTRY NO._________________________
CHAPTER
VOL. NO. ___________________
____________________________________
PAGE NO.
SECTION
Month
Year
___________________
_________________________
CITIZENSHIP BY DESCENT CERTIFICATE INFORMATION
CERTIFICATE NO. ____________________________________
ISSUE DATE _______/_________/________
Day
CHAPTER
____________________________________
SECTION
Month
Year
_________________________
ADOPTION CERTIFICATE INFORMATION
CERTIFICATE NO.____________________________________
ENTRY NO._________________________
BOOK. NO.
________________
PAGE NO.
___________________
MARRIAGE CERTIFICATE INFORMATION
CERTIFICATE NO.____________________________________
ISSUE DATE _______/_________/________
Day
ENTRY NO._________________________
VOL. NO. / BOOK NO.___________
Month
Year
FOLIO NO. / PAGE NO. ________________
REGISTRATION / NATURALISATION CERTIFICATE INFORMATION
CERTIFICATE NO. ____________________________________
ISSUE DATE _______/_________/________
Day
CHAPTER
____________________________________
SWORN DECLARATION
SWORN DECLARATION
SWORN DECLARATION
DEED POLL NO.
SECTION
DATED _______/_________/________
________________________________________
(NAME OF DECLARANT)
DATED _______/_________/________
________________________________________
(NAME OF DECLARANT)
DATED _______/_________/________
________________________________________
DATED _______/_________/________
Day
Day
Day
________________________________________
Month
REF.
_________
REF.
__________
REF.
__________
Year
Month
Year
Month
Year
Month
Year
DATED _______/_________/________
Day
Month
Year
OTHER INFORMATION (Where Necessary)
OFFICER’S STAMP
RECEPTION OFFICER
___________________________________________________
DATE
_______/_________/________
Day
Month
Year
Year
_________________________
________________________________________
(NAME OF DECLARANT)
Day
DECREE ABSOLUTE
Month