"Application Form for a Fiji Passport" - Fiji

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Download "Application Form for a Fiji Passport" - Fiji

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SERIAL NUMBER
Attach original birth certificate
and if applicable marriage
(Official Use)
certificate, deed poll, adoption
(Official Use)
papers together with 2 recent
full face Passport Photos 3.5cm
GOVERNMENT OF FIJI
x 4.5cm colored photo of
applicant. One of the photos to
APPLICATION FOR A FIJI PASSPORT
be certified by the Witnessing
Officer viz: I certify that this
photograph is a true likeness
It is essential to complete this form accurately.
of:
(Please print clearly in ball point pen)
Mr:
_______________________
Applicant’s Surname: Mrs: ________________________________________________________
1.
(Family Name)
Miss:
Forenames: _____________________________________________________________________________________
2.
Previous Names: ________________________________________________________________________________
3.
Full Name of Father: (surname) __________________________ (forenames) _______________________________
4.
Date of Birth: _____________________________
5.
Birth Place: _____________________________
Day
/
Month
/
Year
City / Town / Village / Country
6.
Marital Status:
Single
Married
Widowed
Divorced
7.
Personal Height: _______________
Colour of Eyes: ______________ Colour of Hair: _____________
8.
Visible Distinguishing Marks: _____________________________________________________________________
9.
Work or Occupation: ____________________________ 10.
Name of Employer: ______________________
11. Address of Employer: ___________________________________________________________________________
12. Applicant’s Full Residential Address:
Correspondence Address: (if different)
______________________________________
____________________________________________
______________________________________
____________________________________________
______________________________________
____________________________________________
______________________________________
____________________________________________
Phone Residence: _______________________
Phone Business: ______________________________
13. (A) DOCUMENTS REQUIRED WHEN APPLYING FOR FIRST ISSUE:
(i) Birth Certificate: __________ (ii) Marriage Certificate: ____________
(iii) Divorce Certificate: _________
(Full Extract)
(If you are a married woman)
(If you are a divorced woman)
(iv) Deed Poll Papers: _________ (v) Adoption Papers: _______________ (vi) Death Certificate: ___________
(If you have changed your name)
(If you are an adopted child)
(If widow)
(vii) FNPF/Business/Bank Card; Driving Licence or latest school report
(B) DOCUMENTS REQUIRED IF APPLYING FOR A REPLACEMENT PASSPORT
(i)
If the passport is full, expired or mutilated attach passport only; or _____________________
(ii) If the passport is lost but still valid, attach police report, statutory declaration, newspaper advertisement and birth certificate (full
extract).
14. CERTIFICATE
I CERTIFY THAT THE ABOVE PARTICULARS ARE CORRECT, THAT I AM A CITIZEN OF FIJI AND THAT I AM
NOT A CITIZEN OR NATIONAL OF ANY OTHER COUNTRY. I CERTIFY THAT I POSSESS NO PASSPORT OR
TRAVEL DOCUMENT (OTHER THAN THAT ATTACHED TO THIS APPLICATION OR DECLARED LOST AS IN
ATTACHED STATUTORY DECLARATION AND THAT I HAVE MADE NO OTHER APPLICATION FOR A PASSPORT
OR TRAVEL DOCUMENT SINCE THE PASSPORT OR TRAVEL DOCUMENT NO. ___________________ WAS ISSUED
TO ME.)
15. Applicant’s Signature: ________________________
Date: _____________________
Place: ____________________
Left Thumb Print
Applicant’s Signature
SERIAL NUMBER
Attach original birth certificate
and if applicable marriage
(Official Use)
certificate, deed poll, adoption
(Official Use)
papers together with 2 recent
full face Passport Photos 3.5cm
GOVERNMENT OF FIJI
x 4.5cm colored photo of
applicant. One of the photos to
APPLICATION FOR A FIJI PASSPORT
be certified by the Witnessing
Officer viz: I certify that this
photograph is a true likeness
It is essential to complete this form accurately.
of:
(Please print clearly in ball point pen)
Mr:
_______________________
Applicant’s Surname: Mrs: ________________________________________________________
1.
(Family Name)
Miss:
Forenames: _____________________________________________________________________________________
2.
Previous Names: ________________________________________________________________________________
3.
Full Name of Father: (surname) __________________________ (forenames) _______________________________
4.
Date of Birth: _____________________________
5.
Birth Place: _____________________________
Day
/
Month
/
Year
City / Town / Village / Country
6.
Marital Status:
Single
Married
Widowed
Divorced
7.
Personal Height: _______________
Colour of Eyes: ______________ Colour of Hair: _____________
8.
Visible Distinguishing Marks: _____________________________________________________________________
9.
Work or Occupation: ____________________________ 10.
Name of Employer: ______________________
11. Address of Employer: ___________________________________________________________________________
12. Applicant’s Full Residential Address:
Correspondence Address: (if different)
______________________________________
____________________________________________
______________________________________
____________________________________________
______________________________________
____________________________________________
______________________________________
____________________________________________
Phone Residence: _______________________
Phone Business: ______________________________
13. (A) DOCUMENTS REQUIRED WHEN APPLYING FOR FIRST ISSUE:
(i) Birth Certificate: __________ (ii) Marriage Certificate: ____________
(iii) Divorce Certificate: _________
(Full Extract)
(If you are a married woman)
(If you are a divorced woman)
(iv) Deed Poll Papers: _________ (v) Adoption Papers: _______________ (vi) Death Certificate: ___________
(If you have changed your name)
(If you are an adopted child)
(If widow)
(vii) FNPF/Business/Bank Card; Driving Licence or latest school report
(B) DOCUMENTS REQUIRED IF APPLYING FOR A REPLACEMENT PASSPORT
(i)
If the passport is full, expired or mutilated attach passport only; or _____________________
(ii) If the passport is lost but still valid, attach police report, statutory declaration, newspaper advertisement and birth certificate (full
extract).
14. CERTIFICATE
I CERTIFY THAT THE ABOVE PARTICULARS ARE CORRECT, THAT I AM A CITIZEN OF FIJI AND THAT I AM
NOT A CITIZEN OR NATIONAL OF ANY OTHER COUNTRY. I CERTIFY THAT I POSSESS NO PASSPORT OR
TRAVEL DOCUMENT (OTHER THAN THAT ATTACHED TO THIS APPLICATION OR DECLARED LOST AS IN
ATTACHED STATUTORY DECLARATION AND THAT I HAVE MADE NO OTHER APPLICATION FOR A PASSPORT
OR TRAVEL DOCUMENT SINCE THE PASSPORT OR TRAVEL DOCUMENT NO. ___________________ WAS ISSUED
TO ME.)
15. Applicant’s Signature: ________________________
Date: _____________________
Place: ____________________
Left Thumb Print
Applicant’s Signature
16. IF THIS APPLICATION IS BY A PERSON UNDER 16 YEARS OF AGE, THE FOLLOWING SECTION MUST BE
COMPLETED, BY EITHER PARENT OR LEGAL GUARDIAN.
I, the Parent/Legal guardian of the applicant (forenames) _______________________________________________________________
(Surname) _____________________________________ agree to the issue of a passport valid for all countries for the applicant.
Name of Father: _____________________________________
Signature: _______________________________________
Name of Mother: ____________________________________
Signature: _______________________________________
Legal Guardian: _____________________________________
Signature: _______________________________________
Date of Signature: ___________________________________
Full Address: _________________________________________________________________________________________________
17. Method of Collection: Personal Collection/
18.
Witness: I confirm that I have known the applicant for
years
Post to:
and that he/she signed the certificate (section 14) before me and he/
She fully understood its contents.
____________________________________
Full Name of Witness: ____________________________________
____________________________________
Residential Address: ______________________________________
____________________________________
_______________________________________________________
____________________________________
Position Held: ___________________________________________
____________________________________
Employer/Address: _______________________________________
____________________________________
Signature of Witness: _____________________________________
____________________________________
Date: _______________________________
19. FOR OFFICIAL USE ONLY
VETTING OFFICER:
APPLICATION RECORD CHECK:
Name: ____________________________________
Signature: _________________________________
Date: _____________________________________
Application lodged by: _______________________
VDU OPERATOR – Application Entered
CASHIER
Name: ____________________________________
Name: ________________________________________________
Fees Paid: _________________________________
Signature: _____________________________________________
Revenue Receipt No. ________________________
Date: _________________________________
Signature: _________________________________
Date: _____________________________________
VDU CHECK:
Verified from the Computer Records that the Applicant
Previously held
Fiji Passport No. _____________________________
PASSPORT OFFICER:
Issued on __________________________ and has no
Name: ________________________________________________
Other Foreign passport or watchlisted
Signature: _____________________________________________
Date: ___________________________________
______________________
_______________
VDU Operator
Date
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