Sedal Number

Pnssponr ApplrclnoN FoRM

fullface Atach2 recent passport colour Photoc measuring 3.5cmx 4.5on. bythe Ore phobto becerlified this sare oficerwilnessirg form stating: application

G o m p l e t c v c r yf l e l d o f t h i s f o r m i n h r n d w r i t i n g u r i n g b l o c kl e t t e r s , A p p l i c a nr tusr provlde tworignatures. 1. 2. Applkanb Sumanre:
{F r*tlm)

lutityiltE photqnph is atrue Nanlf') Ikenoss of (App/lcs/f

Firsl Name:

Name: Middle

3. Previous
4. 5. 7. 8. Full name ofFaher: Date ofBirfi:
Dsy tlon0l

Ctty/ Counlt

Madtal Sbhrs: Personal Height

tr Single:

Manied: tr 9.Colour ofEyes:

Wdoued: tr

Divorced: B 10. Colour ofHain

11. Visibledistinguistring marks: 12. Occupation: '14. Address ofEmployen 15. Applicants address: fullresidential
address) 16. Conespondence Address:(ifdiff€ronttron r06identid

13.Name of Employen

(resicentiat) 1 7 . Phone:

Business: Email:

1 8 . FaxNo.: tick boxg Birth Cerlifcate papen Deed Poll

(attach 19. Part number) A: Documents required when applying forfint issue: where andquote originals applicable
n n Maniage Certificate n
lf you e a mtrbd wffi)

' Dirorce Certificate

E tr

papers Adoption


Dea$ C,ertificate

NatrralizationCertificate n

FNPF Electlcity Bill

n tr

Registration Cerlificate fl CreditCard tr WaterBill n

photos n 2tullhcecolour DriversLicene n School report U

passport &kbo(Et B: Documents required if applying fora replacement Part (i) lfpassportistull,expiredormutilated,atbchpassportonly tr
(ii) lf passport butstill valid, attaci: islost ordamaged


passport police islost I county wtrere report from AND AoflmenbtionatPartA E E newspaperadwrtisement StaMorydeclaraiions 20.Cerlification:

nooth* Fiji passpoft or Invel document particulars thatI ama cltizen of FUi.I certifythatI possess I certifythattheabove arecorrect, for andthatI havemede application declantion no oher otlrerapplicatit lolher thatettfihad attlr:hldto Io this apptication annlication declared lostasin attacied aflacieds tabttory tabilowdeclaration or declrred lost lotherthanthet was rssudtone) no. Docungnt a Fijipassportar tftePasspoftarTnvel treveJ docurnentsince Applicants signature: Date: signature: Applicanb Thumb Print:

l)eportment of lmmigrotion.{om w$ion I 120A6

IlVitness: I confirm thatI hwe known theappllcant for andhdrhefully undentandr 16contcntr.gurrdlan of theappllcant (Flrstmd Uiddlcnem!) Surnanc Namc of Fafter.: .Applicalion VDU Operator Enter€d Date of lssue : Nane: Signatune: Date: PasrpoilOfilcer Name: tl€rytrlpdnt of hmtgrailnlorn t:asim I130C'6 Signature:- Datd: . Fulllhmc dWitness: RcldentlalAddrcss: yean andthatheliheslgned theccftification d Scc{ion 20before m Occupatlon: EmployarAddrcn: Slgnrtun dlUilnecs. Data: Email: 23.turo.21' lf $ls application is by a peruon under {0 yean of agehe followlng section by eithcr mustbe completed parent guardlan or legal I. ilamcol lilother: LrgalGurdlan: : Dde: FullAddrss: vrlid lron all dosntrieo agrrcto thelguc of a pargport for thc appllcant Slgn. tlethodofcollection: PcrsonatGoltec{ionor postio: Vat0ng Offlcer Nane: Applbtion Lodged dab: Ofiice Use Only Signatun: Dale: Cshtr Nane: pad:_ Fee I Signature:_ t Dde: Rewrue ReceiptNo.: VIruChec{ Nane: Signature:_ Dde: Date ofExpiry: Cerlified tom he Computer Records bat he 4plicantprcriously heH: F$i Passport No. thr panntllegal. Slgnature: Slgnature: U2.

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