Fillable Printable Lost Passport Notification Form - Immigration Division

Lost Passport Notification Form - Immigration Division

NOTIFICATION FORM FOR A LOST, STOLEN OR MUTILATED

TRINIDAD AND TOBAGO PASSPORT

PLEASE PRINT INFORMATION IN BLOCK LETTERS

USING DARK BLUE OR BLACK INK PEN

THIS FORM IS TO BE FILLED OUT BY THE APPLICANT

& SHOULD BE SIGNED IN THE PRESENCE OF THE

COMMISSION OF AFFIDAVITS OR JUSTICE OF THE PEACE

1. DETAILS OF THE LOSS / STOLEN OR MUTILATED PASSPORT

NAMES IN WHICH THE PASSPORT WAS ISSUED

SURNAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

MIDDLE NAME(S) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

DATE OF BIRTH ___/___ ___/___/___ ___/___/___/___ PHOTOGRAPH

Day Month Year

TOWN / CITY OF BIRTH /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

COUNTRY OF BIRTH /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

PASSPORT NO. /___/___/___/___/___/___/___/___/___/___/___/___/

DATE OF ISSUE ___/___ ___/___/___ ___/___/___/___

Day Month Year

ISSUING OFFICE /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

STATUS OF PASSPORT

2. CURRENT DETAILS (TO BE FILLED ONLY IF DIFFERENT FROM SECTION 1)

CURRENT

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

CURRENT

FIRST N

AME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

CURRENT

MIDDLE NAME

(S)

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

3. CURRENT HOME ADDRESS

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/ HOME TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/

E-MAIL ADDRESS _________________________________________ MOBILE NO. /___/___/___/___/___/___/___/___/___/___/___/

The police must be notified of the loss or theft of the passport. Any passport that is lost or stolen abroad must be reported to the local police o f that

country. Please submit the police lost document report.

4 POLICE REPORT

AS THE LOSS/ THEFT OF THE PASSPORT BEEN REPORTED TO THE POLICE? YES [ ] NO [ ]

DATE REPORTED

TO POLICE ___/___ ___/___/___ ___/___/___/___

Day Month Year

POLICE

STATION

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

LOST STOLEN MUTILATED

WARNING TO ALL APPLICANTS

Any such person who makes a written or oral statement knowingly to be false

or misleadi ng is guil t y of an offence and is liable to fine and imprisonment.

This is to be used to report the loss, theft or m utilation of a Trinidad and Tobago passport.

IMPORTANT : Completing this form will not provide you with a replacement passport

To replace your loss, stolen or mutilated passport, you will need to submit this form, one passport sized photograph, a passport application form,

supporting documents and fee.

IMMIGRATION DIVISION

MINISTRY OF NATIONAL SECURITY

FOR OFFICIAL USE ONLY

PASSPORT CONTROL OFFICER

________________________________

D.C.I.O.

________________________________

5. NAME OF PERSON REPORTING THE LOSS, THEFT OR MUTILATION (complete this section only if you are not the passport holder)

A person with parental responsibility must complete section 5, if the passport holder is under the age of sixteen (16) years (this form should not be used

where there is a parental dispute over the possession of a child’s passport). If you are completing this form on behalf of an adult passport holder please

enclose a covering letter explaining clearly why the passport holder canno t complete this form him/herself.

SURNAME

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

FIRST NAME /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

MIDDLE NAME(S) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

RELATIONSHIP TO PASSPORT HOLDER /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

HOME ADDRESS

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/

/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/ HOME TEL. NO. /___/___/___/___/___/___/___/___/___/___/___/

E-MAIL ADDRESS _________________________________________ MOBILE NO. /___/___/___/___/___/___/___/___/___/___/___/

6. DETAIL HOW, WHEN OR WHERE THE LOSS, THEFT OR MUTILATION OF THE PASSPORT OCCURRED.

HAVE YOU HAD ANY OTHER TRINIDAD AND TOBAGO PASSPORTS LOST, STOLEN OR MUTILATED? YES [ ] NO [ ]

If yes, give details of the previous passport(s)

_______________________________________________________________________________________________________________________________

7. STATE THE COUNTRIES FOR WHICH YOU HAD VISAS ENDORSED IN THE PASSPORT

8. STATE SOME OF THE COUNTRIES YOU HAVE VISITED USING THE PASSPORT.

9.REASON FOR RE-APPLYING FOR A TRNIDAD AND TOBAGO PASSPORT

ATTENTION

The primary purposes for soliciting this information are:

(1) To ensure that no per son s hall bear more than one valid passport at one time except as authorised by the Immigration Division or the Ministry or Foreign Affairs.

(2) To Guard against Identity Fraud or the otherwise unlawful use of your passport by another person.

I the undersigned certify that the above information provided herein is correct and complete and that I have not sold, pledged or otherwise given my passport

to another person or disposed of it in an unauthorized manner. I understand that upon submission of this form, the related passport would be invalidated and

can no longer be used. If the passport is subsequently found or recovered, I will immediately return same to the nearest Immigration Division Office, Embassy,

Consulate or High Commission of the Republic of Trinidad and Tobago.

DATED ___/___ __/___/___ ___/___/ ___/___ ______________________________________________________

Day Month Year Signature of Applicant

IDENTIFICATION ____________________________________

CERTIFICATION BY THE COMMISSIONER OF AFFID AVITS OR JUSTICE OF THE PEACE

Made and subscribed this __________________________ day of _______________________________ in the year ________________________________

before me.

………………………………………………………. …………………………………………………………….

Name in Block Letters Signature

……………………………………………………….

Official Title