Belize Passport Application For Persons 16 Years And Over Page 2
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Section 4. Declaration (Please tick all those that apply)
I, the undersigned, hereby apply for the issue of a Belize passport, I declare that:
□
(A) The information given here is correct to the best of my knowledge and belief;
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(B) I have not lost the status of citizen of Belize;
From the below, please choose that which is applicable
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(C) I have not previously held or applied for a Belize passport.
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(D) Attached is passport number _______________ issued at ___________________ on
____/____/____
I have not made another application for a Belize
(day/month/year).
passport since it was issued and I have surrendered all previous passports;
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(E) Unavailable for presentation passport number________________ issued at _______________
on ____/____/____
. I have attached a statutory declaration attesting to its loss,
(day/month/year)
destruction or being stolen.
Date
______/______/______
Signature (within but not touching
day / month / year
edges of box)
Section 5. Authentication of Application
Authentication of Application
The application form must be authenticated and sponsored in Section 5 by two recommenders; the
recommenders should fill in the forms FORM 3A and FORM 3B.
FORM 3A must be filled by (GROUP A) a Justice of the Peace, Minister of Religion, Medical
Practitioner, Notary Public, or Attorney at Law.
FORM 3B must be filled by (GROUP B) a Member of the House of Representatives, Chief Executive
Officer in any Ministry of the Government of Belize, Head of Department of any Department of the
Government of Belize, or a Licensed Teacher.
Recommender must be acquainted with the applicant for
A. Born Belizean ________ years
B. By Registration________ years
C. By Marriage
________ years
D. By Descent
________ years
WARNING To the applicant and the recommender:
It is a prosecutable offence [contrary to Sections 3 (e) and (h), Chapter 164, Laws of Belize]
to make any false representation with respect to information requested by this form.
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