APPLICATION FOR A GUYANA PASSPORT

1 Republic of GuyanaAPPLICATION FOR A GUYANA PASSPORTFORM ASurname:Maiden Name:First Name:Second Name:Third Name (if any):FOR OFFICIAL USE ONLYP assport No.:_____Dateof issue:_____Indicate whether applicant is:Under 16 years16 and aboveIMPORTANT:READ INSTRUCTIONS CAREFULLY BEFORE COMPLETINGTHIS FORMINSTRUCTIONS ON HOW TO COMPLETE FORM(A)Males(married or single) and women who havebeenmarried(16years of age or over). Complete Sections 1,2, 6 and 7 if appropriate to their own applications .(B)Married womenof any age (including widows andwomen whose marriage haven t been terminated) arerequired to complete Sections 1, 2, 3, 6 and 7 and ifappropriate to their own applications , section 4.

2 (C)Each person will be issued with their own cases whereeither parent is not available an Affidavitfrom a Justice of Peace or Commissioner of Oaths isrequired. The affidavit must indicate that thechild/children is/are in the custody of either parentmaking the representation to apply and uplift thepassportfor the child/children, or that the applicant is theguardian of the child.(D)Signing the 7should be completed by the person (therecommender) verifying the declaration and who mustbe a Member of Parliament, Mayor of City/Town,Regional/ Village Chairman, Attorney-at-Law,Permanent Secretary, Senior Officers of the JointServices ( below the rank ofS u p e r i n t e n d e n t / L i e u t e n a n t )

3 OrHeadmaster/Headmistress/Principalof Schools,Lecturers at Tertiary Institutions, Doctors, Justices of thePeace and Commissioners of Oaths and Affidavits,Business Managers or any person of similar standingpersonally acquainted with the a previous marriage has been dissolved, theapplicantwouldbe required toproducethe final decreeof divorce or recommender must be a citizen of the RepublicofGuyana who would have known the applicant for two(2) yearsor more, but must not be a member of theapplicant simmediate family including mother, father,husband, wife, uncle, aunt,son, daughter, TO BE PRODUCEDAll documents must be produced in duplicate (certifiedcopy or original and photocopy)(E)(i) Males (married or single) and women who1have not been marriedshould produce birthcertificatesor certificates of naturalization orregistration and identification cards as a citizen ofGuyana as the case may require.

4 (ii)Married women(including widows and womenwhose marriage havebeen terminated) applying for apassport should produce documents specified in (i)above, together with marriage certificate.(iii) NOTE: Where an Order has been made by theHigh Court or in Chambers or by a Magistrateregarding the custody of a child, such Order must beproduced and the nature of the Order stated.(iv)Change of Name. If the applicant has changedhis or her name by Deed Poll and has registered thechange the Deed Poll must also be submitted alongwith a recent Birth Certificate (within 6months) asevidence that a change of name has been effected.

5 (v)Persons born outside the Republic of Guyanaas constituted on 3rdNovember, 1978 and all personsclaiming Citizenship by descent, naturalization orregistration , must complete Section 4B and producedocumentary evidence in support of the statementmade there in. birth certificate of descent(Father/mother), naturalization or registrationdocument, or other evidence of colour photograph of the applicant willbe takenat the booth at the Central Immigration and PassportOfficeby a Data Entry Immigration Clerk. You mustsubmit a photograph which must confirm to thefollowing h o t o g r a p h s m us t n o t b e l a r g e rt h a n45 x 35mm ( x in) nor smaller than 32 x26mm ( x in).

6 Portraits taken with a digitalcamera should be at high quality and resolution andbe printed on photo quality recommender is also required to endorse andstamp the reverse sideof the copy of the photographswith the words: I certify that this is a true likeness of Mr., Mrs. andadd his or her AFor official use onlyApplicant s Signature(Do not exceed rectangle)For officialuse only21 GENERAL INFORMATIONS urname (state whetherMr., Mrs., Miss(Sn., Fr., Rev or Dr.):Marital status: Single MarriedDivorced WidowedFirst namesPersonal DescriptionGender: Male FemaleHeight:cmColour of eyes:Hair Colour:Special, peculiar (visible) marks:Maiden Surname: (if applicant is woman who is or has been married)Has name been changed otherwise than by marriage?)

7 NoYesIf so , state original name:NameChange DocumentAge at last birthday:Date of birth (day/mm/yr)Country of Birth:Place of Birth:Profession or occupation:Present address:Usual place of residence:Local telephone no.:fax no.:e-mail:2 CitizenshipStatewhether Citizenship of the Republic of GUYANA by :Birth Naturalization DecentAdoptionRegistrationIf Citizen of the Republic of GUYANA by any of the above, give particulars of supporting Number:Place of Issue: Date of Issue:3 Married women applying for a PASSPORT must complete this s or former husband s surname and full First names:Place of marriage.

8 Date of marriage (day/mm/yr)4 PERSONS BORN IN (A) ANY BRITISH COMMONWEALTH COUNTRY OR IN SOUTHERN IRELAND, IN A BRITISH PROTECTORATE,PROTECTED STATE OR MANDATE OR TRUST OR (B) IN ANY FOREIGN COUNTY MUST COMPLETE A OR B BELOW:If applicant s birth was registered as a citizen of the Republic of GUYANA abroad, state:Name of consulateDate of registrationPlace and date of father s birthB Paticulars of applicant father:If born in GuyanaIf Citizen of GUYANA by Naturalization or REGISTRATIONP lace of birthDate of birthNo.

9 Of CertificateDate and place of IssueTo avoid delay, answers to all relevant sections shouldbecompleted in fill out the form in BLOCK CAPITALSNote: Do not sign form until you have read all the noteson page 1 PhotoPassport NumberABFORM ATo Chief PassportOfficerThis is to certify that, I .. am the legal guardian ofName in hereby authorize you to issue him/her with a PASSPORT of the Republic of of applicant to child. Parent Guardian5 USE OF PASSPORTP assport required for travelling to: ..Purpose of indicate by a tick in the box providedA I the undersigned, hereby apply for the issue of a I declare that the information given in this APPLICATION is correct to the best of my knowledge andbeliefC That I have notlost the statusof Citizenof the Republic of That I have not previously held or applied for a PASSPORT of any That all previous passports granted to me have been surrendered.

10 Other thantravel Document is now attached and that I have made no other applicationfor a PASSPORT since the attached PASSPORT or travel document was issued to :Applies to persons applying for a passportRecommender: that the applicant has been knownPersonally to me that to the best of my knowledge and belief, the facts stated on thisform are true and or Stamp (if any)IMPORTANT: Applicant andrecommender are warned that should any statement contained in their respective declarationsprove to be untrue, the consequences to them may be serious.