Fsm Passport Application Form - Federated States Of Micronesia

ADVERTISEMENT

FSM FORM 5001B-REVISED FORM 5001A
FSM PASSPORT APPLICATION FORM
Applicant Photo
FOR OFFICIAL USE ONLY
Applicant must complete this form and forward it to the
Division of Immigration & Labor, Department of Justice,
Document Issued On: ______________
FSM National Government, Palikir, Pohnpei FM 96941
1 3/16 x 1 ¾
Issuing Official:___________________
PLEASE FOLLOW INSTRUCTIONS
Type of Passport: [ ] Ordinary [ ] Official [ ] Diplomatic
Applicant Information
Name: ___________________________________________
______________________
________________________________________________
Last Name
Middle Initial
First Name
Other Names You Have Used:_________________________________________________________________________________________________________
Date of Birth: __________________________________ Gender
[ ] Miss
[ ] Mrs.
[ ] Ms.
[ ] Mr.
Height: ________________________ Feet _____________________Inches
Hair Color____________________ Eye Color ______________________
Birth Place: ______________________________________ Home Address:____________________________________________________________________
Current Postal Address:______________________________________________________________________________________________________________
Email Address _____________________________________________________________ Phone Number ___________________________________________
Have you ever been issued a foreign passport or FSM passport? [ ] Yes [ ] No
If yes, country of issuance, date issued and passport number_________________________________________________________________________________
Basis of FSM citizen: [ ] Birth [ ] Naturalization [ ] Other means (Provide prove)
Father Information
Last Name:___________________________________ First Name:______________________________________ Middle Name: _______________________
Birthdate: _________________________________ Birthplace: ________________________________________ Is your father FSM citizen? [ ] Yes [ ] No
If no what nationality: __________________________________________________________________________
Mother Information
Last Name:__________________________________ First Name:_______________________________________ Middle Name:_______________________
Birthdate: ________________________________ Birthplace: ________________________________________ Is your mother FSM citizen? [ ] Yes [ ] No
If no what nationality: __________________________________________________________________________
Signature of Applicant Required (Do not sign in the box for infant and adult who cannot
Sign)
Please sign within the box. Signature must not touch box border lines.
Signature of parent or guardian if applicant under age 14 or unable to sign application.____________________________________________________________
Subscribed and sworn to before me this ____________day of ______________ 20
NOTARY PUBLIC SEAL
I hereby certify that I have reviewed the application and found to be complete and I am satisfied that the applicant is a citizen of the Federated States of
Micronesia, and that he/she does not owe allegiance to any foreign country.
____________________________________ _____________________
FSM Immigration Reviewing Officer
Date

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Life
Go
Page of 3