Form 5 - Declaration Of Applicant For Persons Submitting Applications To Belize Foreign Mission

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Form 5
[Regulation 7(1)]
DECLARATION OF APPLICANT
FOR PERSONS SUBMITTING APPLICATIONS TO BELIZE FOREIGN MISSION
I, ______________________________________ of _______________________________________
[insert full name]
[insert full address]
hereby declare that:
(a)
the information provided in my application for a Belize passport for [myself/ the child
___________________________ dated ________________
is true and
[day/ month/ year]
[insert child’s name, if applicable]
[insert date of application]
correct to the best of my knowledge, information and belief;
(b)
I am a citizen of Belize and have not renounced or lost my status as a citizen of Belize;
(c)
that I have/ the above-named child has –
[indicate and complete the applicable option below]
□
not previously held or applied for a Belize passport.
□
previously held passport number ______________issued at _________________
on the ___________
. I have enclosed the said passport with the
[day/ month/ year]
above mentioned application; I have not made another application for a Belize
passport since the said Belize passport was issued and all previous passports to
the said Belize passport have been surrendered.
□
previously held passport number ______________issued at _________________
on the ___________
which is unavailable for presentation. I have
[day/ month/ year]
attached a Declaration of Lost, Stolen or Mutilated Belize Passport in respect of
the said Belize Passport to my application.
Signature of Declarant
Date ___________________
day/ month/ year]
Certification by Notary Public
Made and subscribed this
day of
in the year
before me.
Name:
Signature
Official Title:
Official Stamp and Seal

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