Passport application

                                                  To [MIA service center]

                                      REQUEST
             for issuance (exchange) of a citizen passport of Ukraine

I, [Full name],
date of birth: [date of birth],
place of birth: [place of birth],
registered address: [registered address],
contact phone: [phone],
Tax ID: [Tax ID],

request the issuance (exchange) of a citizen passport of Ukraine.



Reason: [first issuance / reaching 25/45 years / name change / loss / damage / other]



I have been informed about the liability for providing false information.

Attachments:
1. Birth certificate (for first issuance).
2. Previous passport (for exchange).
3. Documents confirming data changes (if applicable).
4. Receipt of administrative fee payment.
5. Photos (if required).

4/12/2026                                                         _______________
                                                                       (signature)