Application For Samoan Passport Page 2
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FA’AMAONIGA
VAEGA B.
CERTIFICATION
SECTION B.
Government of Samoa
Faatonuga
Instructions
O Lē o le a faatumuina ma faamaonia lenei
Certifier who should fill in this section (B)
Vaega (B) o le Talosaga e tatau ona:
of the application must:
1.
Tagatanuu Samoa
1.
Be a Samoan Citizen
2.
E le o se aiga vavalalata
2.
Not an immediate relative
Silafia lē o lo’o talosaga ia lē itiiti i le 2 tausaga
3.
3.
Have known the applicant for at least 2 years
4.
O se tasi o i latou o loo taua i lalo (faamolemole faailoga mai)
4.
Belong to one of the following categories (Please tick)
Loia/poo se Resitara Fai-Tautoga (JP)
Faipule o le Palemene
Lawyer/justice of the Peace
Member of Parliament
Faifeau Ekalesia Kerisiano
Alii/Tamaitai Ofisa Sinia o le malo Samoa i Ofisa i Fafo
Senior Staff – Overseas Missions
Minister of a Christian Religion
Sui auai Sinia o se fa’alapotopotoga Samoa i Atunuu i Fafo
Ofisa Sinia o le Malo poo se Kamupani
Senior Officer of a recognized organisation
Prominent Samoa Community Leader
(Public & Private Sectors)
O a’u o
o
I,
of
(suafa atoa/full name)
(tuatusi/address)
Ou te fa’amaonia atu ou te iloa
i se vaitaimi e
tausaga
Hereby certify that I have known
for a period of
years
(suafa o lē o lo’o talosaga) (applicant)
(no less than two – (2) years)
(e le lalo ifo o le lua (2) tausaga)
O la’u Galuega:
O lo’u Falefaigaluega:
My Occupation:
My Employer:
Tuātusi o le falefaigaluega:
Telefoni:
My Employer’s Address:
Telephone:
Ua maea ona ou saini i tua o le ata tusifolau e tasi o lē o lo’o talosaga?
Ioe
Leai
I have certified the back of one passport photo of the applicant?
Yes
No
Aso
M
T
Saini:
Aso:
Signature:
Date:
DAY
MTH
YR
MALIEGA (Fa’atumu pe a fai o se talosaga mo se tamaititi 16 tausaga ma lalo ifo)
VAEGA C.
SECTION C. CONSENT (please complete if you are applying for a child’s passport under 16 yrs)
Ua iai le mā’ua maliega e tu’uina atu ai le tusifolau i le mā’ua tama ua tā’ua i lalo:
We agree to the issue of a new passport to our child as detailed below:
Nu’u na fānau ai
Alii po’o le tama’ita’i
Igoa
Aso fānau
Name
Birth Place
Date of Birth
Gender
Igoa o le Tamā:
Saini:
Father’s Name:
Signature:
Igoa o le Tinā:
Saini:
Mother’s Name:
Signature:
O a’u o
e fa’amaonia atu, o le maliega
o
I
of
hereby certify that, the foregoing
(suafa/name)
(tuatusi/address)
ua tā’ua i luga na sainia i o’u luma e mātua po o E e va’aia fa’aletulāfono le tamaititi e pei ona tā’ua i luga.
consent was signed in my presence and that the persons who signed that consent are the natural parents/legal guardians of the abovenamed
child.
Aso
M
T
Saini:
Aso:
Signature:
Date:
DAY
MTH
YR
PEPA E MANA’OMIA LE FA’APIPI’I MAI
VAEGA D.
CHECKLIST – TO BE ATTACHED
SECTION D.
Fa’amolemole siaki po o ua atoa pepa fa’amaonia e talafeagai ma lau talosaga.
Please check that you have all appropriate support documents before lodging your application.
Pepa Fa’aipoipo
Pepa Fānau
Birth Certificate
Marriage Certificate
Pepa Matai poo se tusi fa’amaonia
Pepa o suiga fa’aletulāfono o igoa – faatinoina i Samoa
Name Change Document/Deed Poll Document – processed in Samoa
Title Certificate or Confirmation Letter
Pepa Liliu
Pepa Sitiseni
Court Order of Adoption
Citizenship Certificate
Pepa fānau/Pepa fa’aipoipo o mātua pe a sitiseni i le tupuaga
2 Ata
2 Photos
Totogi/Fee
Parents Birth & Marriage Certificate (if applicant is citizen by descent)
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