Fillable Jamaican Passport Application Form

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Jamaican Passport Application Form

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The Jamaican Passport Application Form form is 4 pages long and contains:

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  • 21 check-boxes
  • 104 other fields

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Jamaican Passport Application Form
PLEASE READ THE INFORMATION SHEET CAREFULLY BEFORE COMPLETING THIS FORM
A APPLICANT’S PERSONAL DATA
Profession or Occupation
Marital Status
Single
Divorced Married Widowed
Surname
First Name
Middle Name(s)
Maiden Surname (family name at birth)
Previous Name: (If name has been changed other than by marriage)
Place of Birth: (Town, City and Parish)
Date of Birth
Day Month Year
Sex
Male Female
Height
cm
Eye Colour
Dark Brown
Brown Grey
Grey Blue
Blue Hazel
Chestnut
Black Mixed
Other ……………………………..
Jamaican Passport Application Form Page 1 of 4
Special Visible Features
………………………………………………………………………………………………………………………………………………………………………………
Mother’s First Name
Mother’s Maiden Name (Surname before Marriage)
APPLICANT’S PERMANENT ADDRESS
Street Number and Street name
Town, City and Parish
Country
APPLICANT’S MAILING ADDRESS (If different from permanent address)
Street Number and Street name
Town, City and Parish
Country
Postal or Zip Code
State
Postal or Zip Code
State
Residential Telephone Number
Area Code Seven Digit Number
Business Telephone Number
Area Code Seven Digit Number
E-Mail Address:
B TO BE COMPLETED IF APPLICANT IS OR HAS BEEN MARRIED
Date of Marriage
Day Month Year
Place of Marriage: (Town, City and Parish)
Country:
Spouse’s Name First Name
Surname
Jamaican Passport Application Form Page 2 of 4
FOR
OFFICIAL
ONLY
USE
Signature of the Applicant WITHIN in the box above
Note: years
Thumb Print Box Below
For persons unable to sign
Signature is not required for applicants under the age of 12
C
CONSENT FOR MINOR (Applicable to persons under 18 years of age. Mother, Father or Legal Guardian may give consent)
Particulars of person giving consent to minor
Surname (parent or legal guardian)
First Name
Middle Name(s)
Relationship to above-named person to minor
Mother
Father
Legal Guardian
Declarat
ion of person giving consent:
……………………………………………….. …………………………………………………………..
old a passport.
I (name)
……………………………………
give my consent for ………………………………………………………………………………………………………………………………… to h
………………………………………………………….. ………………………………
ignature of Pa
rent or Legal Guardian Date
…
S
D PARTICULARS OF MOST RECENT PASSPORT: (This information is required whether the passport is expired or current, damaged, lost
or otherwise unavailable)
Passport Number
Date of Issue
Day Month Year
Date of Loss
Day Month Year
Place of Issue
i
rst Name F
iddle Names(s) M
Name in which stolen, lost or unavailable
passport w
as issued
Surname
BRIEF STATEMENT OF CIRCUMSTANCES WHERE PASSPORT HAS BEEN DAMAGED
_
____________________________________________________________________________
Place of Loss (City, Parish):
___________________________________________________
___________________________________________________
E
DECLARATION OF APPLICANT
I, the undersigned, apply for the issue of a Jamaican Passport. I
knowledge and belief. I further declare that:
declare that the information given in this application is correct to the best of my
I have not previously held or applied for a Jamaican Passport
All previous passports granted to me have been surrendered, other than Passport or Travel Document No. ………………………………..
which is submitted herewith.
My passport has been lost or is not available for present use and that I have reported the circumstances to the Police or to the Passport Office
(Kingston) or to the Jamaican Consular representative overseas.
…………………………………………………………………………………
ignature of Applicant
ay Month Year
Date of Declarati
on
…
S
D
F EMERGENCY CONTACT PERSONS
FIRST CONTACT PERSON
Surname
First Name
Middle Names
Street Number and Street name
Town, City and Parish/State
Country
Postal or Zip Code
Telephone Number
Area Code Seven Digit Number
Relationship
SECOND CONTACT PERSON
Surname
First Name
Middle Names
Street Number and Street name
Town, City and Parish/ State
Country
Postal or Zip Code
Telephone Number
Area Code Seven Digit Number
Relationship
G OFFICIAL CERTIFICATION (Please ensure that Sections A-F are completed before certifying this document)
WARNING: IT IS AN OFFENCE TO MAKE A FALSE AND MISLEADING STATE
MENT IN SUPPORT OF A PASSPORT APPLICATION
I………………………………………………………………………………………………………………….. ……………………………………………….
First Name Middle Name(s) Surname Designation/Occupation
hereby certify that I have known …………………………………………………………………………………………………………………………………
Insert full name of applicant (in the case of a minor, the person giving consent) as stated on application.
For. ………………………………(years) and that the information given is correct to the best of my knowledge and belief.
……………………………………………………………..
Signature of Certifying Official
Date of Certification
Day Month Year
Address of Certifying Official
Building/Apartment Number and Name (if applicable)
Street Number and Street name
Town, City and Parish/ State
Country
Postal Code or Zip Code
Telephone Number
Area Code Seven Digit Number
Official Stamp or Seal
(If any)
Jamaican Passport Application Form Page 3 of 4
H TO BE COMPLETED BY APPLICANTS WHO MUST WEAR HEADGEAR FOR RELIGIOUS REASONS
(Religion/Sect)
I TO BE COMPLETED BY APPLICANTS BORN OUTSIDE OF JAMAICA
Father’s Name: Mother’s Name:
Father’s Place of Birth: Mother’s Place of Birth:
Father’s Date of Birth: Mother’s Date of Birth:
J SUPPLEMENTARY INFORMATION
K FOR OFFICIAL USE ONLY
DOCUMENTS SUBMITTED DOCUMENT NUMBER ISSUE DATE PREVIOUS PASSPORT STAMP
BIRTH CERTIFICATE
ADOPTION CERTIFICATE
MARRIAGE CERTIFICATE
NATURALIZATION CERTIFICATE.
REGISTRATION CERTIFICATE
CERTIFICATION OF CITIZENSHIP
DIVORCE CERTIFICATE
DRIVERS’ LICENCE
TAX REGISTRATION NUMBER
ELECTORAL IDENTIFICATION
OTHER
RECEPTION TEAM
(Outpost Staff) Day Month Year
………………………………..
(Passport Office)
…………………………
PRODUCTION TEAM
DATA ENTRY OPERATOR: ……………………………………………………
IMAGE CAPTURE OPERATOR: …………………………………………………
SUPERVISORY REVIEW: ………………………………………………………..
PRINT OPERATOR: ………………………………………………………….
LAMINATOR: …………………………………………………………………
QUALITY ASSURANCE:……………………………………………………...
Jamaican Passport Application Form Page 4 of 4
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Completed 14 December 2020

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