This form must be typed. See DoD 1000.21-R for form completion instructions.
1. DATE PASSPORT OR VISA
2. MAJOR SERVICE COMPONENT
AUTHORIZATION TO APPLY FOR A "NO-FEE"
REQUIRED BY APPLICANT
PASSPORT AND/OR REQUEST FOR VISA
3. APPLICANT'S LAST NAME - FIRST NAME - MIDDLE NAME
4. APPLICANT'S DATE OF
5. APPLICANT'S PLACE OF BIRTH
6. SPONSOR'S LAST NAME - FIRST NAME - MIDDLE NAME
7. SPONSOR'S MILITARY
8. SPONSOR'S SSN
(If same as Item 3, X block)
9.a. APPLICANT'S CURRENT HOME ADDRESS (Include ZIP Code)
b. HOME TELEPHONE NUMBER (Include area code)
c. OFFICE TELEPHONE NUMBER (Include area code/DSN)
10.a. INTERIM ADDRESS WHERE APPLICANT MAY BE CONTACTED
b. NAME OF PERSON WITH WHOM RESIDING
AFTER DEPARTING LOCATION INDICATED IN ITEM 9
(Include ZIP Code)
c. TELEPHONE (Incl. area code)
d. AGENT ID CODE (If applicable)
12. SPECIAL ASSIGNMENT
13. PASSPORT WILL BE FORWARDED TO: (Include complete mailing
11. DESTINATION (Country or
address, building number, room number, ZIP Code, and telephone
14. ESTIMATED DATE OF
15. PROPOSED LENGTH OF
DEPARTURE (From country in
which applicant is currently
16. AUTHORIZING OFFICIAL
a. NAME (Last, First, Middle Initial)
17. ADDITIONAL INFORMATION (Attach continuation sheets if
d. COMPLETE MAILING ADDRESS (Include ZIP Code)
e. TELEPHONE NUMBER (Include area code/DSN)
f. SIGNATURE OF AUTHORIZING OFFICIAL
FOR USE BY ISSUING OR RECEIVING AGENT (Suspense Control)
18. DATE APPLIED FOR PASSPORT
19. PLACE APPLIED FOR PASSPORT
20. NAME OF COURT OR PASSPORT AGENT
21. DATE PASSPORT RECEIVED
22. PASSPORT NUMBER
23. DATE OF PASSPORT
FROM DEPARTMENT OF STATE
25. DOCUMENT(S) INCLUDED WITH
26. COUNTRY AND DATE VISA REQUESTED
27. DATE PASSPORT
28. DATE PASSPORT
RECEIVED WITH VISA
PRIVACY ACT STATEMENT
AUTHORITY: Sections 3012, 8012, 5031, Title 10 USC; 22 CFR 51.63; EO 9397.
PRINCIPAL PURPOSE: To provide authority for issue of "No-Fee" passport and/or request for a visa which is an endorsement stamped or
written on a passport, showing that it has been examined by the proper officials of a country and granting entry into that country. The Social
Security Number is required to verify and/or identify the applicant.
ROUTINE USES: Information is used in conjunction with application for passport/visa and foreign travel. Information may be released to other
DoD agencies, various activities within the Department of State, foreign embassies and consulates.
DISCLOSURE: Voluntary; however, if applicant does not provide information, a "No-Fee" passport cannot be authorized.
*NOTE: If assignment is to Attache; MAAG; JUSMMAT; Security Assistance Liaison Office (SALO); OSP or other Special Advisory Group, e.g.,
CENTO; or any particular assignment that will govern type and need for a passport, enter such information. If not, enter "Not Applicable."
DD FORM 1056, MAY 96
PREVIOUS EDITION MAY BE USED.
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