For Official Use Only

Jamaican Passport Application Form

PLEASE READ THE INFORMATION SHEET CAREFULLY BEFORE COMPLETING THIS FORM

Jamaican Passport Application Form Page 1 of 1

A APPLICANT’S PERSONAL DATA

Surname Profession or Occupation

First Name

Middle Name(s)

Marital Status

Maiden Surname (family name at birth)

Previous Name: (If name has been changed other than by marriage)

Single

Divorced Married Widowed

Eye Colour

Dark Brown

Brown Grey

Place of Birth: (Town, City and Parish)

Grey Blue

Blue Hazel

Chestnut

Black Mixed

Sex Height Date of Birth

Other ……………………………..

Day Month Year

Male Female

Special Visible Features

………………………………………………………………………………………………………………………………………………………………………………

Mother’s First Name Mother’s Maiden Name (Surname before Marriage)

APPLICANT’S PERMANENT ADDRESS APPLICANT’S MAILING ADDRESS (If different from permanent address)

Street Number and Street name Street Number and Street name

Town, City and Parish Town, City and Parish

Country

Postal or Zip Code Postal or Zip Code State State

Residential Telephone Number Business Telephone Number

Area Code Seven Digit Number Area Code Seven Digit Number

E-Mail Address:

B TO BE COMPLETED IF APPLICANT IS OR HAS BEEN MARRIED

Place of Marriage: (Town, City and Parish) Date of Marriage Country:

Day Month Year

Spouse’s Name First Name Surname

Jamaican Passport Application Form Page 2 of 2

FOR

OFFICIAL

ONLY

USE

Signature of the Applicant WITHIN in the box above

Note: years

Thumb Print Box Below

For persons unable to sign

Signature is not required for applicants under the age of 12

CONSENT FOR MINOR (Applicable to persons under 18 years of age. Mother, Father or Legal Guardian may give consent)

Particulars of person giving consent to minor

Surname (parent or legal guardian) Middle Name(s) First Name

Relationship to above-named person to minor

Father

Mother Legal Guardian

Declarat

ion of person giving consent:

……………………………………………….. …………………………………………………………..

old a passport.

I (name)……………………………………

give my consent for ………………………………………………………………………………………………………………………………… to h

………………………………………………………….. ………………………………

ignature of Parent or Legal Guardian Date

…

D PARTICULARS OF MOST RECENT PASSPORT: (This information is required whether the passport is expired or current, damaged, lost

or otherwise unavailable)

Date of Issue Passport Number

Date of Loss

Day Month Year Day Month Year

Place of Issue

Name in which stolen, lost or unavailable

passport was issued

First Name

Surname Middle Names(s)

Place of Loss (City, Parish):

BRIEF STATEMENT OF CIRCUMSTANCES WHERE PASSPORT HAS BEEN DAMAGED

____________________________________________________________________________

___________________________________________________

DECLARATION OF APPLICANT

I, the undersigned, apply for the issue of a Jamaican Passport. I

knowledge and belief. I further declare that:

declare that the information given in this application is correct to the best of my

I have not previously held or applied for a Jamaican Passport

All previous passports granted to me have been surrendered, other than Passport or Travel Document No. ………………………………..

which is submitted herewith.

My passport has been lost or is not available for present use and that I have reported the circumstances to the Police or to the Passport Office

(Kingston) or to the Jamaican Consular representative overseas.

…………………………………………………………………………………

ignature of Applicant

ay Month Year

Date of Declaration

…

Jamaican Passport Application Form Page 3 of 3

F EMERGENCY CONTACT PERSONS

FIRST CONTACT PERSON

Surname First Name Middle Names

Street Number and Street name Postal or Zip Code

Telephone Number

Area Code Seven Digit Number

Town, City and Parish/State

Relationship

Country

SECOND CONTACT PERSON

Surname Middle Names First Name

Street Number and Street name Postal or Zip Code

Telephone Number

Town, City and Parish/ State

Area Code Seven Digit Number

Relationship

Country

G OFFICIAL CERTIFICATION (Please ensure that Sections A-F are completed before certifying this document)

WARNING: IT IS AN OFFENCE TO MAKE A FALSE AND MISLEADING STATEMENT IN SUPPORT OF A PASSPORT APPLICATION

I………………………………………………………………………………………………………………….. ……………………………………………….

First Name Middle Name(s) Surname Designation/Occupation

hereby certify that I have known …………………………………………………………………………………………………………………………………

Insert full name of applicant (in the case of a minor, the person giving consent) as stated on application.

For. ………………………………(years) and that the information given is correct to the best of my knowledge and belief.

Address of Certifying Official

Building/Apartment Number and Name (if applicable)

Street Number and Street name

……………………………………………………………..

Signature of Certifying Official

Town, City and Parish/ State

Date of Certification

Official Stamp or Seal

Day Month Year

(If any)

Country

Telephone Number

Postal Code or Zip Code

Area Code Seven Digit Number

Jamaican Passport Application Form Page 4 of 4

H TO BE COMPLETED BY APPLICANTS WHO MUST WEAR HEADGEAR FOR RELIGIOUS REASONS

(Religion/Sect)

I TO BE COMPLETED BY APPLICANTS BORN OUTSIDE OF JAMAICA

Father’s Name: Mother’s Name:

Father’s Place of Birth: Mother’s Place of Birth:

Father’s Date of Birth: Mother’s Date of Birth:

J SUPPLEMENTARY INFORMATION

K FOR OFFICIAL USE ONLY

DOCUMENTS SUBMITTED DOCUMENT NUMBER ISSUE DATE PREVIOUS PASSPORT STAMP

BIRTH CERTIFICATE

ADOPTION CERTIFICATE

MARRIAGE CERTIFICATE

NATURALIZATION CERTIFICATE.

REGISTRATION CERTIFICATE

CERTIFICATION OF CITIZENSHIP

DIVORCE CERTIFICATE

DRIVERS’ LICENCE

TAX REGISTRATION NUMBER

ELECTORAL IDENTIFICATION

OTHER

RECEPTION TEAM

(Outpost Staff) Day Month Year

………………………………..

(Passport Office)

…………………………

PRODUCTION TEAM

DATA ENTRY OPERATOR: …………………………………………………… PRINT OPERATOR: ………………………………………………………….

IMAGE CAPTURE OPERATOR: ………………………………………………… LAMINATOR: …………………………………………………………………

SUPERVISORY REVIEW: ………………………………………………………..

QUALITY ASSURANCE:……………………………………………………...