BELIZE PASSPORT APPLICATION

Please read the instructions overleaf before completing form.

Section 1.
Surname/Family name Date of birth / Sex: Male Female First & middle names Place of birth (city & country)

(day/month/year)

/ Marital Status: Single Maiden name (Of married women) ; Married ; Divorced ; Widowed

Has name been changed (other than by marriage; e.g., deed poll)? If so, state original name. Home address If home address is not in Belize, address whilst in Belize

Phone no. Occupation

--Residence (country)

Phone no. Height feet

--Colour of eyes inches

Colour of hair

Distinguishing marks/ Special peculiarities

Section 2. Married women (including divorcees and widows) are to complete this section.
Full name of husband Husbands nationality Husbands date of birth

Husbands place of birth

Place of marriage

Date of marriage

Section 3. Citizens of Belize by naturalization are to complete this section.

Number of nationality document Date of issue of document Place of issue of document

Section 4. Declaration (Please tick all those that apply.)

I, the undersigned, hereby apply for the issue of a Belize passport. I declare that: (A) The information given here is correct to the best of my knowledge and belief; (B) I have not lost the status of citizen of Belize; From the below, please choose that which is applicable. (C) I have not previously held or applied for a Belize Passport; (D) Attached is passport number ___________________issued at ________________________ on ______/_______/____________ (day/month/year). I have not made another application for a Belize passport since it was issued and I have surrendered all previous passports; (E) Unavailable for presentation is passport number ___________________issued at ________________________ on ______/_______/____________(day/month/year). I have attached a statutory declaration attesting to its loss, destruction or being stolen.

Signature (within but not touching edges of box)

Date _______/________/_____________ (day/ month/ year)

Section 5. Recommender
I , (Mr., Mrs., Miss) ___________________________________________________________________________ certify that I have known the applicant personally ( Name in print of recommender) for at least one year [my knowledge of applicant is for ________ ] and that to the best of my knowledge and belief, the statements made above are true and correct.
Number of years

Signature ------------------------------------------------------------------------------Profession-------------------------------------------------------------------------------

Date----------------------------------------------------------------------------------------------Address--------------------------------------------------------------------------------------------

FOR OFFICIAL USE ONLY

Documents Submitted Applicants birth cert. Form accepted by------------------------------No.:

Applicants previous passport

No.: Place of issue: Date of issue:

Applicants nationality certificate

No.: Place of issue: Date of issue:

Marriage Certificate
No.: Place of issue: Date of issue:

Other Documents

Date--------/--------------------/-----------------

District: Date of issue: Date of registration:

Cashier------------------------------------------- Date--------/--------------------/----------------- RCR No:------------------------------------------ Amount: $---------------------------Data Entry----------------------------------Supervisor------------------------------------Print Operator------------------------------------QA-----------------------------------

Passport Delivered By-------------------------------------

Passport Received By------------------------------------------------------------------- Date------/----------------/-----------

BELIZE PASSPORT APPLICATION INSTRUCTIONS 1. 2. 3. 4. THIS FORM SHOULD BE CLEARLY WRITTEN IN PRINT WITH BLACK OR BLUE INK. SECTIONS 1 AND 4 OF THIS FORM MUST BE COMPLETED BY ALL APPLICANTS. SECTIONS 2 AND 3 MUST BE COMPLETED BY THOSE TO WHOM THEY APPLY. THE OFFICIAL LANGUAGE IS ENGLISH AND ALL DOCUMENTS SUBMITTED MUST EITHER BE IN ENGLISH OR BE ACCOMPANIED BY A CERTIFIED ENGLISH TRANSLATION OF THAT DOCUMENT.

Authentication of application. The application form must be authenticated and sponsored in Section 5 by a Member of the House of Representatives, Permanent Secretary, Justice of the Peace, Minister of Religion, Medical or Legal Practitioner, Notary Public, or Head of any Department of the Government of Belize. In the case of a person applying abroad at a Belizean Embassy, High Commission, Consulate or Consular Agency, authentication must be by a registered Medical or Legal Practitioner, Notary Public, or Registered Minister of Religion. Documents to be produced. If the applicant is: a) a Belizean by birth (born in Belize) - birth certificate from the Registrar Generals office (for those applying for the first time and those replacing lost, destroyed, or stolen passports) ; previous passport (for those replacing/renewing available passports.) b) a Belizean by descent [born outside Belize to Belizean parent(s) but naturalized] - (i) birth certificate from native country and (ii) his/her naturalization by descent document or other evidence of Belizean nationality. c) a Belizean by registration (born outside Belize but has become a citizen through naturalization) - (i) native birth certificate or passport and (ii) his/her Belize nationality certificate. d) a married woman all of the above that apply plus a marriage certificate (issued by vital statistics or registrars office.) e) a divorced woman wishing to revert to her maiden name all of the above that apply plus the divorce certificate. Photo identification is required from all. This may be in the form of social security and voter registration cards. Drivers licenses are not acceptable.

* For the applicant whose previous passport is now unavailable for submission (be it destroyed, lost, or stolen), a statutory declaration attesting to its particulars
and the reasons for its unavailability along with a report from the Police indicating that the incident leading to the unavailability has been recorded are to be submitted. The statutory declaration, only, is also a requirement for those whose passport is available for presentation but has become damaged. A change of name other than by marriage must be substantiated by the production of evidence showing that a bona fide change has been made for all purposes. Fees. (Effective March 2, 2009) The charge: a) for an ordinary passport (48 pages)

$50.00 for a person of or above the age of 16 years (passport valid for ten years) and $30.00 for a person below the age of 16 years (passport valid for five years); b) for an emergency passport (within five (5) working days $100.00 for a person of or above the age of 16 years (passport valid for ten years) and $60.00 for a person below the age of 16 years (passport valid for five years); c) to replace a lost, damaged, or stolen passport - $85.00 for a person of or above the age of 16 years (passport valid for ten years) and $55.00 for a person below the age of 16 years (passport valid for five years); All fees are payable in cash. What to do with the completed form. The completed form with all necessary documents and fee must be presented personally at the Immigration and Passport Office, Belize City, Immigration and Nationality Headquarters, Belmopan, the Immigration Offices in the district towns of Corozal, Orange Walk, San Pedro, Dangriga, and Punta Gorda or at the Belize Foreign Mission In Los Angeles, New York, Washington D.C., U.S.A., London, U.K., Taipei, Taiwan, and Panama City, Panama. Application forms may be obtained from any of these offices. Passport applications are normally processed within fifteen (15) days. Applications for passports should reach the local offices at least five (5) working days before that on which the passport is required. In the case of persons applying abroad, this is determined by the Foreign Mission; note that fees and processing time at these Missions may vary. WARNING To the applicant and the recommender: It is a prosecutable offence [contrary to Sections 3 (e) and (h), Chapter 164, Laws of Belize] to make any false representation with respect to information requested by this form.