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BELIZE PASSPORT APPLICATION

Passports _____ 8 SCHEDULE 1 Form 1 Regulation 3(1)(a) BELIZE PASSPORT APPLICATION FOR PERSONS 16 YEARS AND OVER Please read the instructions overleaf before completing form. Section 1. Applicant Information Surname/Family name First & Middle names Date of Birth (day/month/year) _____/_____/_____ Place of Birth (city & country) Gender: Male: Female: Marital Status: Single: Married Divorced Widowed Maiden name (Of married women) Has name been changed (other than by marriage, , deed poll)? If so, state original name. Home address Phone no. If home address is not in BELIZE , address whilst in BELIZE Phone no.

B. to replace a lost, damaged, or stolen passport - $85.00 for a person of or above the age of 16 years and $55.00 for a person below the age of 16 years; C. for an emergency passport issued in the event of a medical emergency only (within five (5) working days) – $100.00 for a person of or above the age of 16 years and

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