| Section | Explanation |
|---|---|
| Name and Other Names Used | In this section, write down your complete legal name exactly as it is written on your current identification document under the 'Name' column. If you have other names you're known by, then enter them under the 'Other names used' column. |
| Date of Birth and Sex | Write down your date of birth and check the correct box that identifies your sex. |
| Place of Birth | You are required to provide the city, state, and country in which you were born. |
| Social Security Number | Write down your social security number. |
| Email Address, Primary Contact Phone Number, and Mailing Address | Enter your email address, primary contact phone number, and your complete mailing address, including the ZIP code. |
| Height, Hair Color, Eye Color | Fill in your height, hair color, and eye color. |
| Occupation (Optional), Employer or School (Optional) | You can write your occupation and the name of your employer or school. This section is optional. |
| Permanent Address (If different from mailing address) | If your permanent address differs from your mailing address, provide your permanent address in this section. |
| Travel Plans (Optional) | This section is optional. You can provide your travel plan details, including the countries to be visited, the departure date, and the length of your trip. |
| Emergency Contact | Provide details of your emergency contact person. Include the name, address, and telephone number of that person. |
| Passport Issuance and Expiration Dates | These dates are found in your current passport. The issuance date is when your passport was issued, and the expiration date is when it will expire. |
Be sure to sign and date the form once you have filled out all applicable sections. Remember, making false statements on this form can result in penalties. Also, make sure all family members listed in your current passport are included and that your photo and documents are properly attached. The form must be printed single-sided. The department will not accept double-sided forms.
