![]() APPLICATION for a replacement shall be made by submitting an APPLICATION form, the PASSPORT itself if available, a sworn affidavit detailing the circumstances surrounding the loss, theft, damage or mutilation of the PASSPORT replacement fee in money order or cashiers check payable to the FSM National Treasury, and two identical PASSPORT photos of the applicant.Ħ The Replacement fee for lost, stolen, damage and mutilated shall be $ b) A PASSPORT that has no remaining blank visa pages before the date of expiration may be replaced. PASSPORT Replacement The PASSPORT APPLICATION form must be Notarized a) A PASSPORT that is lost, stolen, damaged or mutilated may be replaced. o Payment of PASSPORT renewal fee payable to the FSM National Treasury in the amount indicated above. ĥ O If basis of FSM Citizen is Naturalization provide copy of Naturalization Certificate PASSPORT Renewal The PASSPORT APPLICATION form must be Notarized o The expired PASSPORT must be submitted with your APPLICATION form o Two Identical PASSPORT photos of the applicant (size: 1 3/16 x 1 PASSPORT photo). o Court Registered Marriage Certificate for maiden name change o In cases of unavailability of records of Birth Certificate, a court registered Baptismal Certificate can be submitted with your APPLICATION form. New PASSPORT (New Applicant) The PASSPORT APPLICATION form must be Notarized o Court Registered Birth Certificate o Two Identical PASSPORT Photos of the applicant (size: 1 3/16 x 1 PASSPORT photo). For new applicant or renewal of expired PASSPORT the following documents are required. Please print all information in Block Letters. This PASSPORT APPLICATION form must be filled out completely, signed and notarize prior to submission to the FSM PASSPORT Office. FSM Immigration Reviewing Officer Date INSTRUCTIONS. I hereby certify that I have reviewed the APPLICATION and found to be complete and I am satisfied that the applicant is a citizen of the Federated States of Micronesia, and that he/she does not owe allegiance to any foreign country.Ĥ _ _. Signature of parent or guardian if applicant under age 14 or unable to sign Subscribed and sworn to before me this _day of _ 20 NOTARY PUBLIC SEAL. Signature must not touch box border lines. Signature of Applicant Required (Do not sign in the box for infant and adult who cannot Sign). Birthdate: _ Birthplace: _ Is your mother FSM citizen? Yes No If no what nationality: _. Birthdate: _ Birthplace: _ Is your father FSM citizen? Yes No If no what nationality: _.ģ Mother Information Last Name:_ First Name:_ Middle Name:_. Father Information Last Name:_ First Name:_ Middle Name: _. ![]() ![]() Basis of FSM citizen: Birth Naturalization Other means (Provide prove). ![]() Have you ever been issued a foreign PASSPORT or FSM PASSPORT ? Yes No If yes, country of issuance, date issued and PASSPORT number_. Height: _ Feet _Inches Hair Color_ Eye Color _. Last Name Middle Initial First Name Other Names You Have Used:_. Type of PASSPORT : Ordinary Official Diplomatic Applicant Information Name: _ _ _. FSM National Government, Palikir, Pohnpei FM 96941. FOR OFFICIAL USE ONLY Applicant Photo Applicant must complete this form and forward it to the Division of Immigration & Labor, Department of Justice, Document Issued On: _.
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