![]() This PASSPORT APPLICATION Form must be filled out completely, signed and notarize prior to submission to the FSM PASSPORT Office. FSM Immigration Reviewing Officer Date INSTRUCTIONS. Signature of parent or guardian if applicant under age 14 or unable to sign Subscribed and sworn to before me this _day of _ 20 NOTARY PUBLIC SEAL.Ĥ I hereby certify that I have reviewed the APPLICATION and found to be complete and I am satisfied that the applicant is a citizen of the Federated States of Micronesia, and that he/she does not owe allegiance to any foreign country. Signature must not touch box border lines. Signature of Applicant Required (Do not sign in the box for infant and adult who cannot Sign). Birthdate: _ Birthplace: _ Is your mother FSM citizen? Yes No If no what nationality: _. Mother Information Last Name:_ First Name:_ Middle Name:_. Father Information Last Name:_ First Name:_ Middle Name: _.ģ Birthdate: _ Birthplace: _ Is your father FSM citizen? Yes No If no what nationality: _. Basis of FSM citizen: Birth Naturalization Other means (Provide prove). Have you ever been issued a foreign PASSPORT or FSM PASSPORT ? Yes No If yes, country of issuance, date issued and PASSPORT number_. Height: _ Feet _Inches Hair Color_ Eye Color _. Last Name Middle Initial First Name Other Names You Have Used:_.Ģ Date of Birth: _ Gender Miss Mrs. Type of PASSPORT : Ordinary Official Diplomatic Applicant Information Name: _ _ _. FSM National Government, Palikir, Pohnpei FM 96941. FOR OFFICIAL USE ONLY Applicant Photo Applicant must complete this form and forward it to the Division of Immigration & Labor, Department of Justice, Document Issued On: _. Signature of parent or guardian if applicant under age 14 or unable to sign Subscribed and sworn to before me this _day of _ 20 NOTARY PUBLIC SEAL I hereby certify that I have reviewed the APPLICATION and found to be complete and I am satisfied that the applicant is a citizen of the Federated States of Micronesia, and that he/she does not owe allegiance to any foreign country.1 FSM FORM 5001B-REVISED FORM 5001A. ![]() Height: _ Feet _Inches Hair Color_ Eye Color _ Birth Place: _ Home Address:_ Current Postal Address:_ Email Address _ Phone Number _ Have you ever been issued a foreign PASSPORT or FSM PASSPORT ? Yes No If yes, country of issuance, date issued and PASSPORT number_ Basis of FSM citizen: Birth Naturalization Other means (Provide prove) Father Information Last Name:_ First Name:_ Middle Name: _ Birthdate: _ Birthplace: _ Is your father FSM citizen? Yes No If no what nationality: _ Mother Information Last Name:_ First Name:_ Middle Name:_ Birthdate: _ Birthplace: _ Is your mother FSM citizen?ģ Yes No If no what nationality: _ Signature of Applicant Required (Do not sign in the box for infant and adult who cannot Sign) Please sign within the box. ![]() 1 FSM form 5001B-REVISED form 5001A FSM PASSPORT APPLICATION form Applicant must complete this form and forward it to the Division of Immigration & Labor, Department of Justice, FSM National Government, Palikir, Pohnpei FM 96941 PLEASE FOLLOW INSTRUCTIONS Type of PASSPORT : Ordinary Official Diplomatic Applicant Information Name: _ _ _ Last Name Middle Initial First Name Other Names You Have Used:_ Date of Birth: _ Gender Miss Mrs.Ģ Ms. ![]()
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