OS/01/01

OS
Please check the accompanying guidance to this form carefully.
GET IT RIGHT Fill in this form in CAPITAL LETTERS and black biro only. Please write only within the white boxes. Your application may be delayed if
USE BLACK BIRO you make a mistake, if you do not enclose the necessary documents or fee, or if you send photos that do not meet our guidance.
ONLY.
We will electronically scan and store the information you provide. Your passport will have a digital image of your photo and signature.
We will check the details you provide using information held by public and private sector organisations in order to determine whether
to issue a passport. Those details may be used by Her Majesty’s Passport Office to test our systems and to ensure the effective
operation of passport services. We may also contact you to ask if you are satisfied with such services. We may pass information held
on your passport and on related passport records to public and private sector organisations in the UK and outside the UK when you
use your passport, obtain a service or when it is in the public interest to do so.
Further information can be found on our privacy statement at www.gov.uk/hm-passport-office.

SECTION What type of passport are you applying for? Put a cross (X) in the relevant box.
Renewal of your passport (If you are an adult, see further
GET IT RIGHT information on section 1 of the guidance notes.)
Adult X Child (under 16)

This form is only for

British applicants Your first British Passport Adult Child (under 16)
from certain countries
applying from outside Replacement for a passport that is lost, damaged or stolen Adult Child (under 16)
the UK. Check
www.gov.uk/overseas-
passports for specific Extension of a passport to full validity Adult Child (under 16)
advice about how to New New Change British
renew or apply for your
passport from the
Changes to your existing passport (the renewal fee applies) name X photo X National status
country you are in. If you want to pay for a 48-page passport, put a cross (X) in this box
This is not available for children.
If you have eyesight difficulties and need a Braille sticker for your passport, put a cross (X) in this box.
Who is the passport for?
SECTION Cross (X) box Mr, Mrs, Miss, Ms, or write your title.
GET IT RIGHT Mr Mrs Miss Ms
X or title

Please include your full Surname

address, including state
or province, and post
F E RR E I R A
First and middle names
code where applicable.
You should include the
international code in
J E NN I F E R I ND I E
Maiden or all previous names (surname first)
the phone number
boxes. F E RR EI R A
Current address (house number, street name, town/city)

ST . J O H N
We will contact you on
your mobile phone MT . NE SB I T
number if we have any
queries about delivery.

If there are any details

that you are not able to
fit in the boxes in
section 2, use the Country Postcode
boxes in section 8 to
provide the information GR E N A D A
in full. Date of birth (DD/MM/YYYY) Gender Cross (X) the relevant box.

10 0 1 1 968 Male Female X

Town of birth

H A M ME R S M I T H
Country of birth (including UK)

EN GL A ND
Mobile phone number Alternative phone number
+1 47 3 42 0 5 6 7 4 + 1 4 7 3 4 2 5 5 35 7
E-mail address (You do not have to fill in your e-mail address in capital letters.)

j e n n i f e r f 6 7 3 4 @g m a i l . c o m
 SECTION Have you had or been included on any sort of passport before? OS/01/02
(You must fill in this section.)
GET IT RIGHT A Has the person named in section 2 had any sort of passport
If you are applying to (British or otherwise) or been included in any passport before? Yes
X Go to 3B below. No
replace a lost or stolen B You must send us all uncancelled passports with the application
passport, you must also (say how many in the box). If the passports are lost or stolen, go to 3C.
fill in form LS01. Please
refer to the guidance 1 Passport number 2 Passport number 3 Passport number
booklet for details on
where to obtain form
LS01. We cannot Lost/Stolen Passport number
process your application c Details of the lost and stolen passport
until you send us form
LS01. If you have Issued at in year
already sent us form
LS01 please tell us at
Section 8. Holders surname at the time it was issued

First and middle names

How the passport was lost, or why it is not available

Date of loss (DD/MM/YYYY) Place of loss

SECTION Parents’ details

If both parents named below were born after 31st December 1982 OR were born outside the UK, we will also need the full name,
town, country, date of birth and date of marriage of your grandparents (or details of your parents claim to British nationality).
GET IT RIGHT Write these details in Section 8, or on a separate piece of paper.
Fill in this section if
you are applying: Mother’s or Parent 1’s full name (surname first)
- for your first adult
British passport
- to replace a British Town and country of birth
passport that has
been lost, stolen or
damaged Date of birth (DD/MM/YYYY) Nationality and citizenship at the time of the applicant’s birth
- for a British passport
for a child under
16, or If they have a British passport, give the number. Date of issue (DD/MM/YYYY)
- to extend a British
passport.
Date of marriage or civil partnership to the father or second parent of the person named in section 2 (if this applies).
If there are details
you are not able to fit
in the boxes in section Father’s or Parent 2’s full name (surname first)
4, use the boxes at
section 8 to include
extra information. Town and country of birth

Date of birth (DD/MM/YYYY) Nationality and citizenship at the time of the applicant’s birth

If they have a British passport, give the number. Date of issue (DD/MM/YYYY)

Office use only

Documents produced
PT OB/EX PT OB/EX PT OB/EX Other documents - specify Block Application
FBC PPT Nat Cert
Payment Payment type
SBC MC Photos Chq PO Csh Cr/
Db
Post opener number Partner Reference

Y N
BOEF
SECTION Certificate of registration or naturalisation OS/01/03
Has the person named in section 2 been granted a certificate of registration or naturalisation?
Cross (X) the box. Date DD/MM/YYYY
No Yes Give the date of issue here
and details below.
Certificate number Place of issue

SECTION Children aged 12-15

If the person named in section 2 is aged 12 to 15, they must sign and date this section
GET IT RIGHT
Please read the notes
on applications for Children’s signature.
children. Section 9 Applications will only be valid if you:
must be signed by a - Sign the white signature box below using black biro
person with parental - Keep within these marks
responsibility for the - Put date in date box to the right Date DD/MM/YYYY
child.

SECTION

GET IT RIGHT
This area is
intentionally blank,
please do not write in
this area

SECTION More information If you need more space, please see the information on section 8 in the guidance notes at www.gov.uk

UN CA NC E L L E D PA S S P O R T I S I N
Y OU R P O SS E S S I O N . PL E A S E SE E
R E L EV ANT P AS SP O R T NU MB E R .

Office use only Office use only

Notes

Type of passport
R SE SN DO DE N O P C
SECTION Declaration This must be filled in by the person named in section 2. If under 16, their parent or guardian must fill this in instead. OS/01/04
It is a criminal offence to make a false statement to get a passport. If you have made a false statement on this form, you
could be prosecuted and could go to prison. Our work includes checking that the countersignature in section 10 is genuine.
I declare that I am 16 years or over (or will be within two weeks) and that:
GET IT RIGHT 1 I will return a lost passport to a UK passport office if it comes into my possession;
If a parent or guardian 2 I, or the person named in section 2 of this application (if different), am a British national and have not lost or given up my national status;
is signing section 9, 3 I have stated if the person named in section 2 was born of a surrogacy arrangement;
they must have 4 I do not owe any money to the UK Government for repatriation or similar relief;
parental responsibility 5 this application does not break the terms of any court order
and should give their to which I, and the person named in section 2 (if different) Signature
relationship to the am subject; Before signing, please read the guidance booklet
child. If the parents 6 as far as I know all the information I have given in this
application is correct; Applications are only valid if you:
are not married, the - Sign the white signature box below using black biro
father will not 7 if the application is for a child, I have parental responsibility
and I have enclosed any court orders that relate to the child’s - Keep within these marks
normally have
parental responsibility. residence, contact or removal from the UK/country of residence;
Please see the 8 I, or the person named in section 2 of this application (if
different), understand that by voluntarily applying for a British
guidance notes for
more details. passport, I may lose my citizenship of another country; and Jennifer I Ferreira
9 I have read both the guidance notes and the caution above
and fully understand the consequences of my actions in
applying for a passport.

Name, if signing on behalf of a child (title, first name and surname)

Relationship to child Date DD/MM/YYYY

SECTION Countersignatory If a countersignature is needed, they must fill in this section after the rest of the form has been filled in.
Caution It is a criminal offence to make a false statement to help someone get a passport. Check the form properly before
you fill in this section. If you have made any false statements on this form, or if you know that the person applying
has made any false statements on this form, you could be prosecuted and could go to prison.
GET IT RIGHT Our work includes checking that your details are genuine. As a result, we may need to contact you. You should not
The person acting as sign this form if you are a relative of the person applying.
the countersignatory IMPORTANT If the application is for a child, you are confirming the identity of the adult signing in section 9. You must
must sign section 10. also be able to identify the child in order to certify the photograph.
Fill in the following in CAPITAL LETTERS and black biro. (cross (X) box Mr, Mrs, Miss, Ms, or write your title)

Mr Mrs Miss Ms or title

GET IT RIGHT First and middle names
Please enclose two
photos that meet the
photo guidance. Surname
On the back of only
one photo, the
countersignatory I confirm that I have known the person named in section 2, or in the case of a child, the adult filling in section 9 (insert their name)
must write “I certify
that this is a true
likeness of...”giving for (insert years) as (please say how - for example, employer, colleague, friend and so on).
the full name and title
of the person named yrs
in section 2. The
countersignatory As far as I know, the information on this form is correct. I hold either a full current British, Irish, other EU, US or
must sign and date Commonwealth passport (delete as appropriate). I have read the caution and I understa nd it.
this endorsement. Profession, professional qualifications or position in the community

GET IT RIGHT Your employer’s name and the address you work at (or your private address if this does not apply)

Designed in the UK by Adare Limited 774485-007 08/13

Please use the boxes at
Section 8 to tell us which
country’s passport your
countersignatory holds,
and his or her email
address.

Postcode Mobile phone number

GET IT RIGHT
To avoid unnecessary
delays, please do not Current passport number Alternative phone number
use a label or stamp
on this form.
Date DD/MM/YYYY Countersignatures will only be
valid if you:
- Sign the white signature box
By countersigning this application, you using black biro
agree to us checking passport records - Keep within these marks
to confirm your countersignature. - Put date in date box to the left