Form I - Particulars Of A Lost Passport Questionnaire - Embassy Of The Republic Of Uganda, Washington D.c.

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EMBASSY OF THE REPUBLIC OF UGANDA
WASHINGTON, D.C.
PARTICULARS OF A LOST PASSPORT QUESTIONNAIRE
1.
Passport Number
……………………………………………………………………………………………………
2.
Where issued and date
……………………………………………………………………………………………...
3.
Full Name of Holder
………………………………………………………………………………………………..
4.
Date and Place of Birth
National Status
…………………………………..
……………………………………..
5.
Has the passport been renewed? If so, where and when?
………………………………………………………
.
6.
Was the passport kept under lock and key? Describe how
……………………………………………………
…………………………………………………………………………………………………………………………
7.
When was your next intended trip scheduled?
…………………………………………………………………..
8.
When and where was the passport last used?
…………………………………………………….……………...
9.
How and when was loss of passport discovered?
……………………………………………………………….
…………………………………………………………………………………………………………………………
10.
Was the loss reported to:
The Passport Office?
……………………………………….
The Police?
……………………………………….
(Indicate dates when you reported)
11.
Have you ever lost a passport?
…………………………………………………………………………………….
12.
Have you ever been refused a Visa?
……………………………………………………………………………...
13.
Have you ever been refused a passport before?
…………………………………………………………………
14.
Are you an undischarged bankrupt?
………………………………………………………………………………
15.
Have you ever been convicted under any immigration laws?
Yes
No
If YES, give details:
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
16.
Have you ever been convicted of a criminal offence in any country?
Yes
No
If YES, give details:
………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………
17.
Where, when and how was the passport last used?
……………………………………………………………..
…………………………………………………………………………………………………………………………
18.
When did you arrive in Uganda, and where did you report?
…………………………………………………..
…………………………………………………………………………………………………………………………
19.
Where did you come from?
………………………………………………………………………………………..
20.
Is your life insured?
………………………………………………………………………………………………...
21.
Have you ever given your passport to an Insurance Company?
Yes
No
If YES, give details:
…………………………………………………………………………………………………….…………………...
22.
What steps did you take to ensure that your passport was being kept in safe custody?
…………………………………………………………………………………………………………………………
23.
Have you ever been imprisoned in Uganda?
Yes
No
If YES, give details:
…………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………
Form “I”
6/01

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