Application For Renewal Of Mauritius Passport Page 2
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2(5) Signature or thumbprint of *applicant/minor
Specimen signature or thumbprint of *applicant/minor
to be shown on the passport. (Failure to comply with
instruction to Keep within inner border lines of the
box below will invalidate this application).
R. Robinson
(specimen signature)
(Use felt pen 0.6mm with black ink only)
Minors only
(6 A) Consent of parents or guardian for application by minors (under 18 years).
I/We, the undersigned, hereby, authorize the issue of a passport to the abovenamed minor. I/We declare that the
information given in the application is correct and that the abovenamed minor has not lost his status of Citizen of Mauritius.
Father/Guardian
Mother/Guardian
………………………………………………………………… ………….……………………………………………………...
Name
Name
……………………………………………………….. ……….. ….……………………………………………………………...
Signature/Right Thumbprint
Signature/Right Thumbprint
…………………………………………………………………. ………………………………………………………………...
NIC or Passport No.
NIC or Passport No.
(6 B) Certification of Consent
I certify that the father and mother or legal guardian affixed his/their signatures/right thumbprint/s under paragraph (6A) above
in my presence.
Rank, Dept. No. and Name of Police Officer: ………………………………………………..…………..………………….…….
.
(in block letters)
……………………….………………………….………….
Signature & date
………………………………
Place where consent given: …………………..………………..
Office Stamp
(7) Declaration of applicant/minor’s parents or guardian
(A) I declare that I am a citizen of Mauritius and have not renounced my citizenship or lost it through acquisition of
another nationality, and the documents and statements produced are true and correct. I am also aware that in
case I have supplied any false information/ document, I am liable to prosecution and any passport issued will be
cancelled.
OR
(B) I declare that my ward is a citizen of Mauritius and has not lost his/her citizenship of Mauritius through
acquisition of another nationality, and the documents and statements produced are true and correct. I am
also aware that in case I have supplied any false information/document, I am liable to prosecution and any
passport issued will be cancelled.
Signature/thumbprint of applicant: ………………………………..……………… Date: ………………………………………..
Or of parents/guardian of minor
Print
( DD/MM/YYYY e.g 30/12/1999 )
FOR OFFICIAL USE ONLY
NAME
INITIAL
Approval
NO OBJECTION CERTIFICATE
Checked name not on record
Processed by
Signature: …………….………………
Payment slip ordered by
Date:……….….………………………
Date
D/Captured by
Checked by:……..…………………….
Scanned by
Printed by
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