Form DS 11 - Application for US Passport

Please complete all information requested below. Failure to do so may result in a delay in the issuance of your passport.
All required fields must be completed before the passport application form can be created - creation of partially completed
forms is not currently supported.[Why?]

When finished, click on the "Create Form" button at the bottom of this page.

Please click here to contact the National Passport Information Center if you have questions or concerns about the
passport application process. Visit our FAQ page for answers to frequently asked questions

Name
First:	Middle:		Last:
Suffix (Jr, Sr, III):	Sex:	Applicant SexMaleFemale	Date of Birth mm/dd/yyyy:
SSN:	Height:		Hair Color:
Eye Color:	Home Phone:		Bus. Phone:
Occupation:	Employer:		E-mail Address: (optional)
City of Birth:	Place of Birth:
Alien Registration: (if applicable)

Mail Passport to

In Care of:
(If Applicable)

Street/PO:

Street 2:

Street 3:

Apt #:

City:

US State/
Territory :

Country:

Postal Code:

Permanent Address

Same as Mailing Address

Note: Do not list P.O. Box

Street/R.F.D.#:

Street 2:

Street 3:

Apt #:

City:

US State/ Territory:

Country:

Postal Code:

Emergency Contact

If you wish, you may supply the info of a person not traveling with you to be contacted in the case of an emergency.

Name:

Street:

Street 2:

Street 3:

Apt #:

City :

US State/ Territory:

Country:

Postal Code:

Telephone:

E Mail:

Relationship:

Father Information

Father

	Last Name:		First Name		Middle Name:
	Birthdate: mm/dd/yyyy		Birthplace:		U.S. Citizen:	Is your father a U.S. citizen?YesNo

Mother Information

Mother

Last Name (Maiden Name):	First Name	Middle Name
Birthdate: mm/dd/yyyy	Birthplace:	U.S. Citizen:	Is your mother a U.S. citizen?YesNo

Spouse or Former Spouse Information

Spouse or Former Spouse

Have you
ever been
married?

Have you ever been married?YesNo

Spouse's or Former Spouse's Full Name:

Birthplace:

Birthdate: mm/dd/yyyy

U.S. Citizen:

Is your spouse a U.S. Citizen?YesNo

Date Of Recent Marriage:

Are you
widowed?:

Are you widowed?

Yes

Are you divorced?

Are you divorced? YesNo

Widowed
or divorced date:

Other Names You Have Used

Other First Name 1:

Other Middle Name 1:

Other Last Name 1:

Other First Name 2:

Other Middle Name 2:

Other Last Name 2:

Other First Name 3:

Other Middle Name 3:

Other Last Name 3:

Other First Name 4:

Other Middle Name 4:

Other Last Name 4:

Miscellaneous Information

Miscellaneous Info

Have you ever been issued a U.S. Passport?

Have you ever been issued a U.S. Passport?YesNo

Name in which issued:

Most recent passport number:

Issue Date:
mm/dd/yyyy

Disposition:

Passport Disposition

Submitted

Lost

Stolen

Other

If Other, please describe:

Travel Plans

Date of Trip: mm/dd/yyyy

Length of Trip:

Countries to be Visited:

Upon clicking the Create Form button, the data you have entered will be verified. If there are errors, you will be prompted to correct the data items in error. If there are no errors, the form Application for U.S. Passport or Registration will be genereted in PDF format and returned to your browser as a file download, giving you the choice to either open or save the file. Clicking on 'Open' will open the file in Adobe Reader where you can then print out the passport application form.

Please print the form on single-sided paper - no double-sided printing. Please look carefully at your form after printing. Compare the printed form to what appears on your screen. Make sure all data blocks and the barcode appear clearly and in the same format. If there are any distortions, smudges, missing blocks or data, and/or fading, it may be due to variations in printer types, printer drivers, and/or low ink levels. If such problems appear and cannot be corrected after checking your printer, do not submit the form. Instead, download a blank form and complete it by hand.

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