Visa/passport Order Form - Usaid Visa And Passport Office
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1USAID Visa and Passport Office
Classified Visa and Passport Services
1300 Pennsylvania Avenue N.W.
Room C1-7
Washington, D.C. 20523
Tel # 202. 842.8617 / 202.842.8618
Fax # 202.842.8619
Visa / Passport Order Form
T/A Number: ___________________
(TA required to use USAID CBA for payment)
Date passport must be back in your possession:
_______ / _______ / _______
mm
dd
yyyy
Traveler's Name: ______________________________________
Traveler's Date of Birth: _____/_____/_____
(As it appears on passport)
mm
dd
yyyy
Phone (Office): _____________
Phone (mobile): _____________
E-mail: ______________________________
Bureau: ______________ Position Title:
_________________________ Office Location/Room #: ____________________
Passport Number: ____________________
Date of Issue: _____ / _____ / _____ Valid Until: _____ /_____ / _____
Purpose of Trip: _______________________________________________________________________________________
Name of Person Requesting This Order: _______________________________________________
Phone: ______________________________________
(If different from Traveler)
Email Address: ________________________________
Passport Service
:
Select the passport service you are requesting by placing a check mark in the appropriate box for each service.
Indicate the type of passport you are requesting the service for.
Please Note: Separate application forms and requirements apply for each passport and visa procedure. Processing times are in business days (not calendar
days) and do not include holidays or embassy closures.
Passport Type
Diplomatic
Official
Regular
Others: _______________
Request :
Regular Service
Expedite Service
Visa Services
:*
Actual US Departure Date: _____ /_____ /_____
mm
dd
yyyy
Official
Entry
Kind of Service
Entry / Exit Dates:
Travel :
S=Single / M=Multiple
Rush or Regular
Country 1 : __________________________
_____
________
From: _____ / _____ / ____ To: _____ /_____/____
mm
dd
yyyy
mm
dd
yyyy
Country 2 : __________________________
_____
________
From: _____ / _____ / ____ To: _____ /_____/____
mm
dd
yyyy
mm
dd
yyyy
Country 3 : __________________________
_____
________
From: _____ / _____ /_____ To: _____ /_____/____
mm
dd
yyyy
mm
dd
yyyy
2 Photos for $8
Terms: By using Classified VPS you are authorizing the company to handle your personal information and your Passport, and to hand over passports and information to a foreign embassy in US for the purpose of
acquiring a Visa. Classified VPS is not responsible for the safety and security of your Passport once the Passport has entered the diplomatic grounds. Classified VPS cannot and does not guarantee a Visa will be issued by
a diplomatic office as this is the sole prerogative of the foreign government.
Payment Method for Applicable Fees:
American Express:
Diners Club:
Master Card:
Visa:
This card is a:
Personal Card
USAID CBA (TA Required)
Name on Card: ____________________________________________________________________________________________________
Card Number: ________________________________________ Expiration Date: _________ / __________ / __________
mm
yyyy
Zip Code
Signature:
Date:
______________________________
__________________
Classified VPS will automatically charge the credit card on file / TA
Two days after email notification.
Multiple Stops /Follow-Up (After 2 attempts) are subject to additional fee.
* Regular Passport is subject to Consular Fees
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