Dutch Passport Application
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Starting June 27
till June 30
, 2016, the Royal Netherlands Embassy in cooperation with the Netherlands
Consulate General in Chicago will use a mobile station to hold a Dutch passport application session at the
Consulate General in Chicago on address:
303 E. Wacker Drive, Suite 2600, Chicago, IL 60601.
Initially this service is offered to passport applicants who cannot reasonably be expected to visit one of the
designated offices for physical or medical (e.g. elderly or disabled people). Secondly this service is offered
to the remaining passport applicants in the area.
If you would like to request an appointment at this location and take advantage of this opportunity, you
need to respond by, complete and return the forms and documents mentioned below a.s.a.p. and no later
than June 3rd, 2016.
You are strongly advised to read and follow these instructions carefully and in their entirety.
APPLICANTS
Enter the members of your household who need to apply for a Dutch passport in the table below. Use the
Notes field to indicate any special circumstances that support your appointment and approval request.
APPLICANT
LAST DUTCH PASSPORT
US IMMIGRATION STATUS
FIRST NAME
LAST NAME
AGE
YEAR ISSUED AVAILABILITY
HOLDER OF VALID
O In possession
O visa/green card
O Lost/stolen
O US passport
O In possession
O visa/green card
O Lost/stolen
O US passport
O In possession
O visa/green card
O Lost/stolen
O US passport
O In possession
O visa/green card
O Lost/stolen
O US passport
O In possession
O visa/green card
O Lost/stolen
O US passport
O In possession
O visa/green card
O Lost/stolen
O US passport
NOTES:
If renewing Dutch passport after having acquired another nationality, please indicate here,
mentioning date of US naturalization.
APPLICANT CONTACT INFORMATION
The Consular Offices of the Royal Netherlands Embassy and the Consulate General will inform you a.s.a.p.
IF your application is admissible. If approved, you will receive information on setting an appointment and
any further instructions if necessary.
Please enter your contact information in the table below.
STREET ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS
HOME PHONE
CELL PHONE
THIS FORM HAS BEEN COMPLETED BY
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