Belize Passport Application For Persons Below The Age Of 16 Years
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1
2BELIZE PASSPORT APPLICATION
FOR PERSONS BELOW THE AGE OF 16 YEARS
Please read the instructions overleaf before completing form.
Section 1. Child Information
Surname/Family name
First & Middle names
Date of Birth
Place of Birth
(city & country)
(day/month/year)
______/______/______
Gender: Male:
Has name been changed (e.g., deed poll)?
Female:
If so, state original name.
Home address
If home address is not in Belize, address whilst in Belize
Phone no.
Phone no.
Occupation
Residence (country)
Height
Colour of eyes
feet
inches
Colour of hair
Distinguishing marks/ Special peculiarities
Section 2. Applicant’s (Parent) Information
Parent: Father:
Full Names of Child’s Parent
Dates of Birth
(day/month/year)
Mother:
Mother: ________________________________
______/______/______
Legal Guardian:
Father: ________________________________
______/______/______
Legal Guardian: __________________________
______/______/______
Applicants’s Place of Birth
Applicants’s Nationality
Marital Status of Parents:
Single:
Married
Divorced
Widowed
Section 3. Citizens of Belize by naturalization are to complete this section.
Number of Nationality Document
Date of Issue of Nationality Document
Place of issue of Nationality Document
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;
□
(B) I have not lost the status of citizen of Belize;
From the below, please choose that which is applicable
□
(C) I have not previously held or applied for a Belize passport.
□
(D) Attached is passport number _______________ issued at ___________________ on ____/____/____
(day/month/year).
I have not made another application for a Belize passport since it was issued and I have surrendered all previous passports;
□
(E) Unavailable for presentation passport number________________ issued at _______________
on ____/____/____
. I have attached a statutory declaration attesting to its loss, destruction or being stolen.
(day/month/year)
Date
______/______/______
Signature of Parent/Guardian
day / month / year
Signature of Child
(Sign within but not touching box)
Date
______/______/______
day / month / year
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 4 – A and FORM 4 – B.
FORM 4 – A must be filled by (GROUP A) a Justice of the Peace, Minister of Religion, Medical Practitioner, Notary Public, or Attorney
at Law.
FORM 4 – B 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
Applicant
C. By Marriage
________ years
Photo here
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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Parent category: Life