APPLICATION FORM FOR TRINIDAD AND TOBAGO PASSPORT

(APPLICANTS 16 YEARS AND OVER)

Specimen Signature of Applicant

WARNING TO ALL APPLICANTS AND RECOMMENDERS

Any such person who makes a written or oral statement knowingly to be false

or misleading is guilty of an offence and is liable to fine and imprisonment.

PLEASE PRINT INFORMATION IN BLOCK LETTERS

USING DARK BLUE OR BLACK INK PEN

PASSPORT _________ ORIGIN _____________ RECEIPT # _______________ PASSPORT # __________________

TYPE

EXPEDITED _________ PICK UP _____________ DATE _______________ DATE OF ISSUE _________________

PRE-PAID REASON FOR

SHIPPING ____________ APPLICATION _____________ VALID TO _________________

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FIRST NAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

MIDDLE NAME(S)

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

MAIDEN NAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FORMER NAME

SURNAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

MOTHER’S MAIDEN NAME

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FATHER’S FULL NAME

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FIRST NAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

2. PERSONAL INFORMATION

DATE OF BIRTH _______/_______/_______ SEX MALE [ ] FEMALE [ ] PHOTOGRAPH

Day Month Year

PLACE OF BIRTH /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

TOWN /CITY

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

COUNTRY

HEIGHT (CM) ____________ COLOUR OF EYES /___/___/___/___/___/___/___/___/___/___/

HAIR COLOUR /

___/___/___/___/___/___/___/___/___/___/

MARITAL STATUS

: SINGLE [ ] MARRIED [ ] WIDOWED [ ] DIVORCED [ ]

SEPARATED [ ] OTHER [ ]

OCCUPATION / PROFESSION /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

HOME ADDRESS

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Street Name Town/ City

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Town /City Zip Code Country

MAILING ADDRESS (IF DIFFERENT FROM HOME ADDRESS)

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Street Name Town/ City

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Town /City Zip Code Country

WORK ADDRESS, OR IF RESIDENT ABROAD, LOCAL ADDRESS

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Street Name Town/ City

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Town /City Zip Code Country

NAME OF FIRM / ORGANIZATION

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

HOME TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/

MOBILE NO. /___/___/___/___/___/___/___/___/___/___/___/

OFFICE TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/

E-MAIL ADDRESS ___________________________________________

FOR OFFICIAL USE ONLY

(*N.B. * This form will become void if the Specimen Signature touches the Border)

DO NOT BEND OR FOLD

MARRIED WOMEN

PRESENT MARRIAGE DATE OF MARRIAGE ______/_______/_______ PLACE OF MARRIAGE _________________________________________

Day Month Year

HUSBAND ‘S NAME

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FIRST NAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

NATIONALITY

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

PREVIOUS MARRIAGE (S)

Date of Marriage (Date/Month/Year) Husband’s Name in Full Place of Marriage Husband’s Nationality

3. PERMISSION FROM PARENT / LEGAL GUARDIAN FOR APPLICANTS UNDER 18 YEARS OF AGE

I, FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

SURNAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Solemnly declare that I am the _________________________________________ of the Applicant, and hereby give permission to

(RELATIONSHIP)

FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

To apply for a Trinidad and Tobago Passport.

4. DECLARATION OF RECOMMENDER * (To be completed by the Recommender Only) *

I, FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Solemnly declare that I am a citizen of Trinidad and Tobago and to the best of my

knowledge and belief, all statements made in this application form are true. I make

this declaration from my knowledge of the applicant whose name is:

NAME OF APPLICANT

FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

SURNAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Whom I have known personally for …………………………………………… years and whose photograph I have certified on the reversed side (applicable

to renewals only).

MY OCCUPATION /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

NAME OF FIRM / ORGANIZATION AND ADDRESS

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Name of Firm / Organization

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Street Name Town/ City

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

Town /City Zip Code Country

OFFICE TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/ HOME TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/

Dated _______/_________/________ I.D./ D.P. / PASSPORT # _______________________________ Date of Issue _______/_________/________

Day Month Year Day Month Year

Date of Expiry _______/_________/________

Day Month Year

Signature of

Recommender

Dated __________/__________/__________

Day Month Year

I.D./ Passport # of

Parent /Legal Guardian _______________________________

Date of Issue __________/__________/__________

Month Yea

OFFICIAL STAMP OF

FIRM / ORGANIZATION

Signature of Parent/ legal Guardian

5. CITIZEN OF TRINIDAD AND TOBAGO BY:

(A) BIRTH [ ]

PIN NO. _______________________________________ CERTIFICATE NO. _________________________________________

REGISTRATION DATE _______/_________/________ REGISTRATION DISTRICT ____________________________________

Day Month Year

(B) DESCENT [ ]

CERTIFICATE NO. ___________________________ ISSUE DATE _______/_________/__________

Day Month Year

CERTIFICATE NO. ___________________________ ISSUE DATE _______/_________/__________

Day Month Year

(D) REGISTRATION [ ] / NATURALISATION [ ]

CERTIFICATE NO. __________________________ ISSUE DATE _______/_________/__________

Day Month Year

ARE YOU NOW OR HAVE YOU EVER BEEN A CITIZEN OF ANY COUNTRY OTHER THAN TRINIDAD AND TOBAGO? YES [ ] NO [ ]

If yes, please provide details below

COUNTRY CITIZENSHIP BY CERTIFICATE NO. ISSUE DATE (Date/Month/Year)

6. TRINIDAD AND TOBAGO PASSPORT(S) PREVIOUSLY

Have you applied for or been issued any Trinidad and Tobago Passport(s) or other Trinidad and Tobago travel Documents? YES [ ] NO [ ]

7. ADDITIONAL REFERENCES

Please provide the following information with respect to two persons who are not relatives and have known you for at least three years.

These persons may be contacted to confirm your identity.

(i)

FIRST NAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

SURNAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

HOME ADDRESS or BUSINESS ADDRESS (IN FULL)

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

TEL. CONTACT /___/___/___/___/___/___/___/___/___/___/___/

(ii)

FIRST NAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

SURNAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

HOME ADDRESS or BUSINESS ADDRESS (IN FULL)

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

TEL. CONTACT /___/___/___/___/___/___/___/___/___/___/___/

8. DECLARATION OF APPLICANT

I ____________________________________________________________________________________ solemnly declare that :

(i) I am a Trinidad and Tobago citizen.

(ii) The statements made in this application are true.

(iii) The photographs enclosed are a true likeness of me.

(iv) I do not have a Trinidad and Tobago Passport other than the one(s) listed at section 6.

(v) I know the recommender for at least three years; and

(vi) I shall report to the Passport Office or the nearest Trinidad and Tobago Government Office any change in citizenship.

PASSPORT NO. DATE OF ISSUE (Date/Month/Year) PLACE OF ISSUE

If YES, list in the Table provided and

submit most recently issued document

Signature

DATED ________/________/____________

Day Month Year

I.D. / PASSPORT # _____________________________

DATE OF ISSUE ________/________/____________

Month Yea

FOR OFFICIAL USE ONLY

PREQUALIFICATION OFFICER ______________________________________ DATE _______/_________/________

Day Month Year

BIRTH CERTIFICATE INFORMATION

COMPUTER GENERATED CERTIFICATE [ ]

PIN NO._______________________________________ CERTIFICATE NO.____________________________________

REGISTRATION DISTRICT ________________________________________ REGISTRATION DATE _______/_________/________

Day Month Year

ENTRY NO._________________________

MANUAL CERTIFICATE [ ]

CERTIFICATE NO.____________________________________

REGISTRATION DISTRICT ________________________________________ REGISTRATION DATE _______/_________/________

Day Month Year

ENTRY NO._________________________ VOL. NO. ___________________ PAGE NO. ___________________

CHAPTER ____________________________________ SECTION _________________________

CITIZENSHIP BY DESCENT CERTIFICATE INFORMATION

CERTIFICATE NO. ____________________________________ ISSUE DATE _______/_________/________

Day Month Year

CHAPTER ____________________________________ SECTION _________________________

ADOPTION CERTIFICATE INFORMATION

CERTIFICATE NO.____________________________________

ENTRY NO._________________________ BOOK. NO. ________________ PAGE NO. ___________________

MARRIAGE CERTIFICATE INFORMATION

CERTIFICATE NO.____________________________________ ISSUE DATE _______/_________/________

Day Month Year

ENTRY NO._________________________ VOL. NO. / BOOK NO.___________ FOLIO NO. / PAGE NO. ________________

REGISTRATION / NATURALISATION CERTIFICATE INFORMATION

CERTIFICATE NO. ____________________________________ ISSUE DATE _______/_________/________

Day Month Year

CHAPTER ____________________________________ SECTION _________________________

SWORN DECLARATION ________________________________________ DATED _______/_________/________ REF. _________

(NAME OF DECLARANT)

Day Month Year

SWORN DECLARATION ________________________________________ DATED _______/_________/________ REF. __________

(NAME OF DECLARANT)

Day Month Year

SWORN DECLARATION ________________________________________ DATED _______/_________/________ REF. __________

(NAME OF DECLARANT)

Day Month Year

DEED POLL NO. ________________________________________ DATED _______/_________/________

Day Month Year

DECREE ABSOLUTE ________________________________________ DATED _______/_________/________

Day Month Year

OTHER INFORMATION (Where Necessary)

RECEPTION OFFICER ___________________________________________________

DATE _______/_________/________

Day Month Year

OFFICER’S STAMP