Passport Application Form M Page 2
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1
2
3Were you born abroad?
Previous passport
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□
See Note 4
Yes
No
Is the previous passport attached?
If yes, see Note 3 and then complete this section.
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Yes
No
If no go to section 6
If yes, previous passport number______________________
If no go to section 8
Father’s details
His full name: ____________________________________
Give details of previous passport which has
His place and country of birth: _______________________
been lost or is not available. See Note 5
_______________________________________
His date of birth: __________________________________
Number: _______________ issued at __________________
Mother’s details
on (date) _________________________________________
Her full name: ____________________________________
Your name at the time of issue: _______________________
Her place and country of birth: _______________________
________________________________________________
Circumstances in which passport was lost or why it is not
Her date of birth: __________________________________
available: ________________________________________
_________________________________________________
Grandparent’s details
_________________________________________________
His/her full name: _________________________________
Place and date of loss: ______________________________
His place and country of birth: _______________________
________________________________________________
Has loss been reported to the police ? __________________
His date of birth: __________________________________
If father/mother is a citizen of Antigua and Barbuda by
naturalisation or registration
Number of his/her document: ________________________
Place and date of issue: _____________________________
Certification See Note 6
If applicant’s birth was registered at a Consulate of
Antigua and Barbuda state:
I certify that the applicant has been known personally to me
Name of Consulate: ________________________________
for _______________ (state period) and this is the true
photograph of the applicant.
Number of registration certificate: ____________________
Full name in block capitals _______________________
Occupation____________________________________
Date: ____________________________________________
Address_______________________________________
Signature and Date______________________________
Supporting documents produced. See
Note 3
Official Stamp
(if any)
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Birth certificate
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Marriage certificate
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Baptismal certificate
Other (please specify) _______________________________
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