Republic of Guyana APPLICATION FOR A GUYANA PASSPORT FORMA ORES SORRENTO RR SB SR Sumame Marden Name: Name Second Name Third Name (any Passport No. Indicate whether applicant Is. CD Under 16 years C116 and above FOR OFFICAL USE ONLY Date of issue: IMPORT: READ IN: Titel (A) Males (married or single) and women who have been married (16 years of age oF over), Complete Sections 1, 2, 6 and 7 if appropriate to their own applications (B) Married women of any age (including widows and women whose marriage haven been terminated) are required to complete Sections 1. 2. 3. 6. and 7 and if appropriate to ir own applications, section 4 (CYEAEHPEFION will be issued with their own passport. In cases where either parent is not available an Affidavit from a Justice of Peace or Commissioner of Oaths is required. The affidavit must indicate that the child/children is/are in the custody of either parent king the ieprescutation wW apply aint uplift die passport for the child/children, or that the applicant is the ‘guardian ofthe child. (D) Signing the form Section 7 should be completed by the person (the recommender) verifying the declaration and who must be a Member of Parliament, Mayor of City/Town, Regional/ Village Chairman, Attorney-at-Law, Permanent Secretary, Senior Officers of the Joint Services (not below the rank of Assistant Superintendent/Lieutenant) or Headmaster/Headmistress/Principal of Schools. Techirers at Tertiary Institutions, Daciars, lustiees of the Peace and Commissioners of Oaths and Affidavits, Business Managers or any person of similar standing personally acquainted with the applicant. When a previous marriage has been dissolved, the applicant would be required to produce the final decree of divorce or annulment. recommender must be @ citizen of the Republic uyana who would have known the applicant for two 2) years or more, but must not be a member of the appiicant's immediate family including, mother, father, husband, wife, uncle, aunt, son, daughter, ete pocum: PRODUCED documents must be produced in duplicate ified copy or original and photocopy) (£) (i) Males (married or single) and women who aera STRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. Pa | been married should produce birth certificates stificates of naturalization or registration and identification cards as a citizen of Guyana as the case mayrequire. (ii) Married women (including widows and women whose marriage have been terminated) applying for a passport should produce documents. specified in (i) above, together with marriage certificate. (iii) NOTE: Where an Order has been made by the High Court or in Chambers or by a Magistrate regarding the custody of a child, such Order must be produced and the nature of the Order stated (iv) Change of Name. If the applicant has changed his ‘arher nama hy Nord Pail nd hac mgistered the change the Deed Poll must also be submitted along with your Birth ertificate as evidence that @ change of namé has been effected (s) Persons born outside the Republic of Guyana as constituted on 3" November, 1978 and all persons claiming Citizenship by descent, naturalization or must complete Section 4B and produce documentary evidence in support of the statement made there in. e.g. birth certificate of descent (Father/mother), naturalization or registration document, or other evidence of citizenship, PHOTOGRAPHS The colour photograph of the applicant will be taken at the booth at the Central Immigration and Passport Office by a Data Entry Immigration Clerk. When this is not possible for any valid reason, you must submit a photograph which must confirm to the following specfications, Photographs must not be larger than 45 x 35mm (1.77 x 138 in) nor smaller than 32x 26mm (1.26 x 102 in). Portraits taken with a digital camera should be at high quality and resolution and be printed on photo quality paper. The recommender is also required to endorse and stamp the reverse side ofthe copy ofthe photographs with the words: "IL cortify that this is a true likeness of Mr, Mrs. or Miss. nd add his or her signature,FORMA. LL To avoid delay, answers tal relevant sections should be completed ink Pleae fil out the form in BLOCK CAPITALS ne: Bo i Forolfical usc only tem rm youve ada ea rae Applicant Signer (Do ma nseed Tana) ‘Surname (state whet Mr, Mrs., Miss( Sn, Fr, Rev. or Di Marital status: Osingte Oma Divorces id widowed Fist name Personal Description mn mnarvied) Gender: []Male [] Female ‘Maiden Surname: (ir applicant is woman who Is or has be Flas name been changed otherwise than by mariage? LINo Elves Ifo, state original name: Colour of eyes: Name Change Document ‘i Age at last birthday: | Date of birth dayrmmiyn Hair Colour Country of Bi Place of Binh Special, peculiar (visible) marks: Profession or occupation: Present address Usual place of residence: 2 Citizenship ana by:: sinh C)Naturatisation Ces If Citizen of the Republic of Guyana by any of the above, give particulars of supporting document. Document Number: Place of Issue Dat sua sent Cadoption DRegistration whether Citizenship of the Republic of C farried women applying for a passport must complete this se Husband's or former husband's sumame and full Fitst names: Place of marriage Date of marriage (day many) Potten Mma ene inert Perr SC ust a RO emote ere eee Lie AT Ifapplicant’s birth was registered as.a citizen of the Republic of Guyana abroad, state: Name of Date of registration an B | Particulars of applicant's father If bora in Guyana If Citizen of Guyana by Naturalisation or REGISTRATION of Cerificate Date and Place of Issue Place of bith Date of BintFORMA To Chief Passport Officer ---- am the legal guardian of This isto certify that, 1. ‘Name in full Thereby authorize you to issue hinvher with a passport ofthe Republic of Guyana. Relationship of applicant to child. [] Parent Guardian Passport required for travelling to: ae — Purpose of travel Please indicate by a tick in the box provided by apply forthe issue of a passport TI A-1 the undersigned 1 bt declare ta the information given in his application scomec tothe best of my knowlege and belie (1D. That have not previously held pei fora passer CE. Thatall previous passports granted to me have been surrendered, other than ni No. which 18 now attached and that Thave made no other application, Ded roe ate certify thatthe applicant has been known Recommender: [eenneeenn Personally ro me for his torm are true and correct. years and that tothe best of my knowledge a Date ener Rank or Profession ose 7 Address ass . Office Stamp (if any) and recommender a IMPORTANT: Applica ‘wamed that should any statement contained in their respective declarations prove mie, the consequences to them may be serious. The attention of persons who are asked to sign this declaration is specially called to the fact that it should be signed from personal knowledge of the applicant and not from information obtained from persons, least two (2) years. and that they should know the applicantet Surname First Name Gender Passport number Oate Oemate Dawe of binh Date of sme Place of inh Tianament (Ragiewavian) Na Document Type Was police notified Date of loss Date of recovery Date of police notification Police Report No, Place of loss js Place of issue _—$—<—$ Recovery measures Remarkw/ Observations Thereby certify that the above particulars are correct and undertake that in the event of the passport coming again into my possession it will be handed over to the Passport Office or the nearest Police Station in Guyana or Guyana Consulate Overseas. ee agente ORONLE PCDI T Ue en ao certificate Other docume Applicant's birth certificate Passport fee S: Receipt #: ae Received by: Checked by Passport signed by Signature:..