Passport Application Form Fsm 5001 printable pdf download

INSTRUCTIONS

This Passport Application Form FSM-5001, must be filled out completely, signed and notarized

by the applicant at any notary public prior to submission to the FSM Passport Office. Please

print all information on this Application Form in Block Letters.

For new passport (new applicant) or renewal of expired passport, the following document is

required to be submitted with the Application Form FSM-5001.

New Passport (New Applicant)

o Court Registered Birth Certificate

o Two Identical Photographs of the applicant (size: 1

x 1 ¾)

3/16

o Registered Marriage Certificate is required for married name.

o In cases of unavailability of records of Birth Certificate, a court registered Baptismal

Certificate can be submitted with your application form.

o Payment of passport fee is payable to the FSM National Treasury in the amount of the

following fees schedule.

◊

$15.00 for Age 0 to 2 years old

◊

$25.00 for Age 3 to 17 years old

◊

$25.00 for Age 60 and older

◊

$50.00 for Age 18 to 59 years old

Passport Renewal

o The expired passport must be submitted with your Application Form FSM-5001

o Two Identical photographs of the applicant (size: 1

x 1 ¾)

3/16

o Payment of passport renewal fee is payable to the FSM National Treasury in the amount

as set above and is based on applicant’s current age.

Passport Replacement

a) A passport that is lost, stolen, damaged or mutilated may be replaced. Application for a

replacement shall be made by submitting an Application Form FSM-5001, the passport

itself if available, a sworn affidavit setting forth fully the circumstances surrounding the

loss, theft, damage or mutilation of the passport, the replacement fee in money order or

cashiers check payable to the FSM National Treasury, and two identical photographs of

the applicant. The Replacement fee shall be $75.00 for a regular adult passport, $50.00

for a regular children’s and senior citizens passport and $40.00 for a regular infant’s

passport.

b) A passport that has no remaining blank visa pages before the date of expiration may be

replaced. Application for a replacement shall be made by submitting an Application

Form FSM-5001, the passport, a fee of $25.00 in money order or cashiers check payable

to the FSM National Treasury and two identical photographs of the applicant.

c) A passport issued to an infant under 12 months may be replaced. Application for a

replacement shall be made by submitting an Application Form FSM-5001, the passport,

and two identical photographs of the applicant.

Passport Application Form Fsm 5001

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