Application Form For Trinidad And Tobago Passport (Applicants 16 Years And Over) Page 3

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5. CITIZEN OF TRINIDAD AND TOBAGO BY:
(A)
BIRTH
[ ]
PIN NO.
_______________________________________
CERTIFICATE NO.
_________________________________________
REGISTRATION DATE
_______/_________/________
REGISTRATION DISTRICT
____________________________________
Day
Month
Year
(B)
DESCENT
[ ]
CERTIFICATE NO.
___________________________
ISSUE DATE
_______/_________/__________
Day
Month
Year
(C)
ADOPTION
[ ]
CERTIFICATE NO.
___________________________
ISSUE DATE
_______/_________/__________
Day
Month
Year
(D)
REGISTRATION [ ] / NATURALISATION [ ]
CERTIFICATE NO.
__________________________
ISSUE DATE
_______/_________/__________
Day
Month
Year
ARE YOU NOW OR HAVE YOU EVER BEEN A CITIZEN OF ANY COUNTRY OTHER THAN TRINIDAD AND TOBAGO? YES [ ] NO [ ]
If yes, please provide details below
COUNTRY
CITIZENSHIP BY
CERTIFICATE NO.
ISSUE DATE
(Date/Month/Year)
1.
2.
3.
6. TRINIDAD AND TOBAGO PASSPORT(S) PREVIOUSLY
Have you applied for or been issued any Trinidad and Tobago Passport(s) or other Trinidad and Tobago travel Documents?
YES [ ] NO [ ]
PASSPORT NO.
DATE OF ISSUE
PLACE OF ISSUE
(Date/Month/Year)
If YES, list in the Table provided and
submit most recently issued document
7. ADDITIONAL REFERENCES
Please provide the following information with respect to two persons who are not relatives and have known you for at least three years.
These persons may be contacted to confirm your identity.
(i)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
HOME ADDRESS or BUSINESS ADDRESS (IN FULL)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/
TEL. CONTACT
(ii)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
FIRST NAME
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
SURNAME
HOME ADDRESS or BUSINESS ADDRESS (IN FULL)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/
TEL. CONTACT
8. DECLARATION OF APPLICANT
I
____________________________________________________________________________________
solemnly declare that :
(i) I am a Trinidad and Tobago citizen.
(ii) The statements made in this application are true.
(iii) The photographs enclosed are a true likeness of me.
(iv) I do not have a Trinidad and Tobago Passport other than the one(s) listed at section 6.
(v) I know the recommender for at least three years; and
(vi) I shall report to the Passport Office or the nearest Trinidad and Tobago Government Office any change in citizenship.
DATED
________/________/____________
Day
Month
Year
I.D. / PASSPORT #
_____________________________
Signature
DATE OF ISSUE
________/________/____________
Day
Month
Year

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