Printed in the United Kingdom for SPSL 000740 300k 04/01
I the undersigned, declare that
1 I have made no other application for a passport, other than that
stated above.
2 I am in the country of application.
3 (delete if not appropriate) If the passport mentioned in section 7 comes
again into my possession, I will return it immediately to a British
passport issuing authority.
4 I do not owe money to Her Majesty’s Government for repatriation or
similar relief.
5 I have not been adopted outside the United Kingdom or dependent
territories, except as mentioned in Section 9.
6 I am a British citizen or
British Dependent Territories citizen or
British Overseas citizen or
British subject or
British protected person.
And I have not lost or renounced this status.
7 All information in this application is correct to the best of my knowledge
and belief.
Sign Date
IMPORTANT - KEEP WITHIN BORDER.
Failure to comply with this instruction will invalidate the application.
Countersignature THIS SECTION MUST BE
COMPLETED BY THE COUNTERSIGNATORY
❊ See note 7
1 Please read the CAUTION below
2 Endorse the back of the photograph by writing ‘I certify that this is a
true likeness of (insert name of applicant)’ and add your signature, and
the date on which the likeness was compared. Read what the applicant
has put on this form, and
3 Fill in the following in capital letters and in ink
I (insert your full name)
certify that the applicant has been known personally to me for years,
and that to the best of my knowledge and belief the facts stated on this
form are correct.
I am a Commonwealth citizen/citizen of
SIGN
Profession (and professional
qualifications, if applicable)
Name of firm, business address
or official stamp (if applicable)
Daytime telephone no. Date
Declaration
To be signed by all applicants
Checklist
When you have completed the form
Please check that you have enclosed all of the following:-
Documents–see note 9......................................
Fee–see note 10 ...............................................
Photographs (one certified on back)–see note 11
and remember to sign the form at section 11 ‘Declaration’ and if
appropriate, section 10.
IT IS IMPORTANT THAT ALL APPLICANTS READ NOTES 9 TO 12
I, (full name of parent)
declare that my rights in respect of
(insert names of children)
have not been limited in any way by the order of any court having
jurisdiction over him/her/them.
Signature
Relationship to child Date
Address
Go to section 11
Declaration of parent
(If applicant is under 18 years)
❊ See note 6
CAUTION
You are warned that the making of an untrue statement for the
purpose of procuring a passport is a criminal offence. The
application should not be countersigned until the form has been
completed, signed and dated by the applicant.
FOR OFFICIAL USE ONLY