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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

BIRTH

6. SPONSOR'S LAST NAME - FIRST NAME - MIDDLE NAME

7. SPONSOR'S MILITARY

8. SPONSOR'S SSN

RANK/CIVILIAN GRADE

(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

REQUIRING PASSPORT*

address, building number, room number, ZIP Code, and telephone

Countries)

(See Note)

number/DSN)

14. ESTIMATED DATE OF

15. PROPOSED LENGTH OF

DEPARTURE (From country in

STAY

which applicant is currently

16. AUTHORIZING OFFICIAL

residing)

a. NAME (Last, First, Middle Initial)

17. ADDITIONAL INFORMATION (Attach continuation sheets if

b. GRADE

c. TITLE

necessary)

d. COMPLETE MAILING ADDRESS (Include ZIP Code)

e. TELEPHONE NUMBER (Include area code/DSN)

f. SIGNATURE OF AUTHORIZING OFFICIAL

g. DATE

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

24. PASSPORT

FROM DEPARTMENT OF STATE

ISSUE

EXPIRATION DATE

25. DOCUMENT(S) INCLUDED WITH

26. COUNTRY AND DATE VISA REQUESTED

27. DATE PASSPORT

28. DATE PASSPORT

PASSPORT

RECEIVED WITH VISA

MAILED

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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Dd Form 1056 - Authorization To Apply For A "No-Fee" Passport And/or Request For Visa

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