Passport Application Form M
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1
2
3For Official Use
Application Number …………...………
Applicant’s name (Complete form in ink and capital letters, if handwritten)
Given Names:__________________________________________________________________
Surname:______________________________________________________________________
IMPORTANT: Read all instructions carefully before completing the form. If you do not complete
all of the sections as indicated, your application is likely be refused.
Application for Antigua and Barbuda Passport
for applicants under 16
Do NOT use this form if you are over 16- use Form L.
Write all dates using the format day/month/year
To be completed by all applicants
Reason for passport application
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Tick box(es) as appropriate
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Child’s details
1- New (First Time) issue
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2- Reissue of Expired passport
Surname: ___________________________________________
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3- Reissue of full passport
Given Names: _______________________________________
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4- Reissue of lost/stolen passport
___________________________________________________
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5- Reissue of damaged passport
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Permanent address: ___________________________________
6- Reissue due to name change
___________________________________________________
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7- Reason for name change: Marriage
___________________________________________________
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Adoption
___________________________________________________
___________________________________________________
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Deed-poll
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8- Other (please specify below)
Date of birth: ________________ Age last birthday ________
Comments: ____________________________
_____________________________________________
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Height (ft):_________________ Sex: Male
Female
_____________________________________________
_____________________________________________
Place of birth: _______________________________________
_____________________________________________
Distinguishing marks (if any):___________________________
___________________________________________________
___________________________________________________
National status
___________________________________________________
Citizen of Antigua and Barbuda by:
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birth
descent
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naturalisation
registration
If by naturalisation or registration:
Type of application
Number of certificate of citizenship/ naturalisation:
See Note 1
________________________________________________
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□
Date of issue: _____________________________________
Standard
Emergency
Passport number of country of birth: ___________________
Place and Date of issue:______________________________
_________________________________________________
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