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
Yd

First
6.Bir$place:
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:(ifdiffronttron 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

(fyouGadiw)

E tr

papers Adoption

Dea$ C,ertificate
0r$dmo

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

Of

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

21'

lf $ls application is by a peruon under {0 yean of agehe followlng section by eithcr mustbe completed parent guardlan or legal
I, thr panntllegal.gurrdlan of theappllcant (Flrstmd Uiddlcnem!) Surnanc Namc of Fafter; ilamcol lilother: LrgalGurdlan: : Dde: FullAddrss: vrlid lron all dosntrieo agrrcto thelguc of a pargport for thc appllcant

Slgn.turo;
Slgnature:

Slgnature:

U2.

IlVitness: I confirm thatI hwe known theappllcant for andhdrhefully undentandr 16contcntr. Fulllhmc dWitness: RcldentlalAddrcss:

yean andthatheliheslgned theccftification d Scc{ion 20before m Occupatlon:

EmployarAddrcn:

Slgnrtun dlUilnecs; Data:

Email:

23.

tlethodofcollection:

PcrsonatGoltec{ionor

postio:

Vat0ng Offlcer Nane: Applbtion Lodged dab:

Ofiice Use Only

Signatun:
Dale:

Cshtr
Nane: pad:_ Fee

Signature:_
t

Dde:

Rewrue ReceiptNo.:

VIruChec{
Nane:

Signature:_

Dde: Date ofExpiry:

Cerlified tom he Computer Records bat he 4plicantprcriously heH: F$i Passport No.: - Applicalion VDU Operator Enterd Date of lssue :

Nane:

Signatune:

Date:

PasrpoilOfilcer Name:
tlrytrlpdnt of hmtgrailnlorn t:asim I130C'6

Signature:-

Datd: