docs.templates.passport-ds11.name

Date of Application: 19/10/2026

SECTION 1 — APPLICANT INFORMATION

Full Name: [Applicant Full Name]

Date of Birth: [MM/DD/YYYY]

Social Security Number: [XXX-XX-XXXX]

Mailing Address: [Applicant Address]

Place of Birth: [City, State/Country]

SECTION 2 — PARENTS

Father's Full Name: [Father's Full Name]

Mother's Full Name (at birth): [Mother's Full Maiden Name]

SECTION 3 — TRAVEL PLANS

[Travel plans: countries to be visited, approximate dates, purpose of travel]

SECTION 4 — DECLARATION

I declare under penalty of perjury under the laws of the United States of America (22 U.S.C. § 212) that the statements made in this application are true and correct to the best of my knowledge and belief. I understand that any false statement made in this application may be punishable by fine, imprisonment, or both (18 U.S.C. § 1001).

I have not been issued a U.S. passport previously under this or any other name, except as noted on this application. I have not been disbarred from receiving a passport pursuant to 22 U.S.C. § 2714.

SECTION 5 — EXECUTING OFFICER (to be completed by Acceptance Agent / Notary)

NOTE: This is a template for guidance only. Laws vary by state. Seek legal advice for your specific situation. Submit Form DS-11 in person at an acceptance facility with proof of citizenship, photo ID, a passport photo, and applicable fees. See travel.state.gov for current requirements.