护照申请表模板.
护照填写申请表全集文档
护照填写申请表全集文档(可以直接使用，可编辑实用优质文档，欢迎下载）注：本表适用于按台（套）进行登记的设备。
注：本表适用于按使用单位进行登记的特种设备。
1 登记类别：填写本次办理使用登记的事由，如新设备首次启用、停用后启用、改造、使用单位更名、使用地址变更、过户、移装、达到设计使用年限等。
2 设备基本情况2.1设备种类、类别、品种：按照《特种设备目录》填写。
没有品种的划“-”。
2.2产品名称：按照产品铭牌或者产品合格证，产品数据表内容填写，也称设备名称。
2.4 型号（规格）：按照产品合格证、产品数据表或者相应的设计文件填写，有型号的填写型号，没有型号有规格的填写规格，与产品铭牌表述应当一致。
没有型号、规格的，划“-”。
2.5 产品编号：填写制造单位为产品编制的制造编号、出厂编号等，其产品合格证、产品数据表和产品铭牌表述应当一致。
2.6 注册代码：由登记机关按照设备代码的编制要求填写。
2.7设计使用年限：按照产品数据表提供的数据填写。
技术资料中未提供的，划“-”。
2.8 制造单位名称、日期：填写产品的制造单位名称及制造日期，其与产品合格证和产品铭牌表述应当一致。
2.9施工单位名称、日期：填写登记时最近一次从事安装或者改造、修理的施工单位的名称及施工日期。
2.10设备数量：压力管道填写本次登记时的压力管道长度（单位为“米”）。
气瓶填写本次登记时的数量（单位为“只”）。
3 设备使用情况3.1 使用单位名称：填写使用单位名称（全称），如果属于公民个人，则填写姓名。
使用单位名称应当与含有单位统一社会信用代码的证明文件一致，个人姓名应与身份证件一致。
3.2 使用单位地址：填写使用单位的注册地址，应包含所在的陕西省西安市、区（县）、街道（镇、乡）、小区（村）、门牌号等，并与营业执照等相关证照表述一致。
3.3使用单位统一社会信用代码：填写使用单位的统一社会信用代码。
如果属于公民个人，则填写个人身份证号。
3.4 邮政编码：填写使用单位所在地的邮政编码。
美国护照申请表
See page 2 of the instructions for detailed information on the completion and submission of this form.FAILURE TO PROVIDE INFORMATION REQUESTED ON THIS FORM, INCLUDING YOUR SOCIAL SECURITY NUMBER,MAY RESULT IN SIGNIFICANT PROCESSING DELAYS AND/OR THE DENIAL OF YOUR APPLICATION.APPLICATION FOR A U.S. PASSPORTPLEASE DETACH AND RETAIN THIS INSTRUCTION SHEET FOR YOUR RECORDSI applied:Place:Date:WHAT TO SUBMIT WITH THIS FORM:1. PROOF OF U.S. CITIZENSHIP (Evidence of U.S. citizenship that is not damaged, altered, or forged will be returned to you.)2. PROOF OF IDENTITY (You must present your original identification AND submit a photocopy of the front and back side with your passport application.)3. RECENT COLOR PHOTOGRAPH (Photograph must meet passport requirements – full front view of the face and 2x2 inches in size.)4. FEES (Please visit our website at for current fees.)WHERE TO SUBMIT THIS FORM:Please complete and submit this application in person to one of the following acceptance agents: a clerk of a federal or state court of record or a judge or clerk of a probate court accepting applications; a designated municipal or county official; a designated postal employee at an authorized post office; an agent at a passport agency (by appointment only); or a U.S. consulate official at a U.S. embassy or consulate, if abroad. To find your nearest acceptance facility,visit or contact the National Passport Information Center.1. PROOF OF U.S. CITIZENSHIPAPPLICANTS BORN IN THE UNITED STATES: Submit a previous U.S. passport or certified birth certificate. Passports that are limited in validity will need to be supplemented by other evidence. A birth certificate must include your full name, date and place of birth, sex, date the birth record was filed, the seal or other certification of the official custodian of such records (state, country, or city/town office), and the full names of your parent(s).- If the birth certificate was filed more than 1 year after the birth: It must be supported by evidence described in the next paragraph.- If no birth record exists: Submit a registrar's notice to that effect. Also, submit a combination of the following evidence: an early baptismal or circumcision certificate, hospital birth record, early census, school, medical, or family Bible records, or newspapers or insurance files. Notarized affidavits of persons having knowledge of your birth may be submitted in addition to some of the records listed above. Evidence should include your given name and surname, date and/or place of birth, and the seal or other certification of the office (if customary) and the signature of the issuing official. Visit for details.APPLICANTS BORN OUTSIDE THE UNITED STATES: Submit a previous U.S. passport, Certificate of Naturalization, Certificate of Citizenship, Report of Birth Abroad, or evidence described below:- If you Claim Citizenship through Naturalization of Parent(s): Submit the Certificate(s) of Naturalization of your parent(s), your foreign birth certificate (and official translation if the document is not in English), and proof of your admission to the United States for permanent residence.- If you Claim Citizenship through Birth Abroad to One U.S. Citizen Parent: Submit a Consular Report of Birth (Form FS-240), Certification of Birth (Form DS-1350 or FS-545), or your foreign birth certificate (and official translation if the document is not in English), proof of citizenship of your parent, your parents' marriage certificate, and an affidavit showing all of your U.S. citizen parents' periods and places of residence/physical presence in the United States and abroad before your birth.- If you Claim Citizenship through Birth Abroad to Two U.S. Citizen Parents: Submit a Consular Report of Birth (Form FS-240), Certification of Birth (Form DS-1350 or FS-545), or your foreign birth certificate (and official translation if the document is not in English), parents' marriage certificate, proof of your parents' citizenship, and an affidavit showing all of your U.S. citizen parents' periods and places of residence/physical presence in the United States and abroad before your birth.- If you Claim Citizenship through Adoption by a U.S. Citizen Parent(s): Submit evidence of your permanent residence status, full and final adoption, and your U.S. citizen parent(s) evidence of legal and physical custody. (NOTE: Acquisition of U.S. citizenship for persons born abroad and adopted only applies if the applicant was born on or after 02/28/1983.)ADDITIONAL EVIDENCE: You must establish your citizenship to the satisfaction of the acceptance agent and Passport Services. We may ask you to provide additional evidence to establish your claim to U.S. citizenship.NOTE: You may receive your newly issued document and your returned citizenship evidence in two separate mailings. If you are applying for both a passport book and passport card, you may receive three separate mailings; one with your returned citizenship evidence; one with your newly issued passport book, and one with your newly issued passport card.2. PROOF OF IDENTITYYou may submit items such as the following containing your signature AND a photograph that is a good likeness of you: previous or current U.S. passport book; previous or current U.S. passport card; driver's license (not temporary or learner's license); Certificate of Naturalization; Certificate of Citizenship; military identification; or federal, state, or municipal government employee identification card. Temporary or altered documents are not acceptable.You must establish your identity to the satisfaction of the acceptance agent and Passport Services. We may ask you to provide additional evidence to establish your identity. If you have changed your name, please see for instructions.IF YOU CANNOT PROVIDE DOCUMENTARY EVIDENCE OF IDENTITY as stated above, you must appear with an IDENTIFYING WITNESS who is a U.S. citizen, non-citizen U.S. national, or permanent resident alien who has known you for at least 2 years. Your witness must prove his or her identity and complete and sign an Affidavit of Identifying Witness (Form DS-71) before the acceptance agent. You must also submit some identification of your own.3. RECENT COLOR PHOTOGRAPHSubmit a color photograph of you alone, sufficiently recent to be a good likeness of you (taken within the last six months), and 2x2 inches in size. The image size measured from the bottom of your chin to the top of your head (including hair) should not be less than 1 inch and not more than 1 3/8 inches. The photograph must be color, clear, with a full front view of your face, and printed on thin paper with a plain light (white or off-white) background. The photograph must be taken in normal street attire, without a hat, head covering, or dark glasses unless a signed statement is submitted by the applicant verifying the item is worn daily for religious purposes or a signed doctor's statement is submitted verifying the item is used daily for medical purposes. Headphones, "bluetooth", or similar devices must not be worn in passport photographs. Any photographs retouched so that your appearance is changed are unacceptable. Snapshots, most vending machine prints, and magazine or full-length photographs are unacceptable. Digitized photos must meet the previously stated qualifications and will be accepted for use at the discretion of Passport Services. Visit our website at for details and information.4. FEES● If you are sixteen years of age or older: Your passport will be valid for 10 years from the date of issue except where limited by the Secretary of State to a shorter period. (See information below about the additional cost for expedited service.)● If you are under sixteen years of age: Your passport will be valid for 5 years from the date of issue except where limited by the Secretary of State to a shorter period. (see information below about the additional cost for expedited service.)BY LAW, THE PASSPORT FEES ARE NON-REFUNDABLE. PLEASE VISIT OUR WEBSITE AT FOR CURRENT FEES.● The passport processing, execution, and security fees may be paid in any of the following forms: Checks (personal, certified, or traveler's) with the applicant's full name and date of birth printed on the front; major credit card (Visa, Master Card, American Express, and Discover); bank draft or cashier's check; money order (U.S. Postal, international, currency exchange), or if abroad, the foreign currency equivalent, or a check drawn on a U.S. bank. All fees should be payable to the "Department of State" or if abroad, the appropriate U.S. embassy or U.S. consulate. When applying at a designated acceptance facility, the execution fee will be paid separately and should be made payable to the acceptance facility. NOTE: Some designated acceptance facilities do not accept credit cards as a form of payment.● For faster processing, you may request expedited service. Please include the expedite fee in your payment. Our website contains updated information regarding fees and processing times for expedited service. Expedited service is available only in the United States.● If you desire OVERNIGHT DELIVERY SERVICE for the return of your passport, please include the appropriate fee with your payment.● An additional fee will be charged when, upon your request, the U.S. Department of State verifies issuance of a previous U.S. passport or Consular Report of Birth Abroad because you are unable to submit evidence of U.S. citizenship.● For applicants with U.S. government or military authorization for no-fee passports, no fees are charged except the execution fee when applying at a designated acceptance facility.NOTE REGARDING MAILING ADDRESSES: Passport Services will not mail a passport to a private address outside the United States. If you do not live at the address listed in the "mailing address" then you must put the name of the person and mark it as "In Care Of." If your mailing address changes prior to receipt of your new passport, please contact the National Passport Information Center.If you choose to provide your email address in Item #6 on this application, Passport Services will use that information to contact you in the event there is a problem with your application or if you need to provide information to us.FEDERAL TAX LAWSection 6039E of the Internal Revenue Code (26 USC 6039E) requires you to provide your Social Security Number (SSN), if you have one, when you apply for a U.S. passport or renewal of a U.S. passport. If you have not been issued a SSN, enter zeros in box #5 of this form. If you are residing abroad, you must also provide the name of the foreign country in which you are residing. The Department of State must provide your SSN and foreign residence information to the Department of Treasury. If you fail to provide the information, you are subject to a $500 penalty enforced by the IRS. All questions on this matter should be directed to the nearest IRS office.If you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your account for the amount of the check. The debit from your account will usually occur within 24 hours and will be shown on your regular account statement.You will not receive your original check back. We will destroy your original check, but we will keep the copy of it. If the EFT cannot be processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT cannot be completed because of insufficient funds, we may try to make the transfer up to two times and we will charge you a one-time fee of $25, which we will also collect by EFT.NOTICE TO CUSTOMERS APPLYING OUTSIDE A STATE DEPARTMENT FACILITYPassport service fees are established by law and regulation (see 22 USC 214, 22 CFR 22.1, and 22 CFR 51.50-56) and are collected at the time you apply for the passport service. If the Department fails to receive full payment of the applicable fees because, for example, your check is returned for any reason or you dispute a passport fee charge to your credit card, the Department of State will take action to collect the delinquent fees from you under 22 CFR Part 34 and the Federal Claims Collection Standards (see 31 CFR Parts 900-904). In accordance with the Debt Collection Improvement Act (Pub.L. 104-134), if the fees remain unpaid after 180 days and no repayment arrangements have been made, the Department will refer the debt to the Department of Treasury for collection. Debt collection procedures used by Treasury may include referral of the debt to private collection agencies, reporting of the debt to credit bureaus, garnishment of private wages and administrative offset of the debt by reducing or withholding eligible federal payments (e.g. tax refunds, social security payments, federal retirement, etc.) by the amount of your debt,including any interest penalties or other costs incurred. In addition, non-payment of passport fees may result in the invalidation of your passport. An invalidated passport cannot be used for travel.REMITTANCE OF FEESOTHER USES OF SOCIAL SECURITY NUMBERS PAPERWORK REDUCTION STATEMENTPublic reporting burden for this collection of information is estimated to average 85 minutes per response, including the time required for searching existing data sources, gathering the necessary data, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State,Washington, DC 20520-2202.IMPORTANT NOTICE TO APPLICANTS WHO HAVE LOST OR HAD A PREVIOUS PASSPORT BOOKAND/OR PASSPORT CARD STOLEN A United States citizen may not normally bear more than one valid or potentially valid U.S. passport book or more than one valid or potentially valid U.S. passport card at a time. Therefore, when a valid or potentially valid U.S. passport book or U.S. passport card cannot be presented with a new application, it is necessary to submit a Form DS-64, Statement Regarding a Lost or Stolen Passport. Your statement must detail why the previous U.S. passport book or U.S. passport card cannot be presented.The information you provide regarding your lost or stolen U.S. passport book or passport card will be placed into our Consular Lost or Stolen Passport System. This system is designed to prevent the misuse of your lost or stolen U.S. passport book or passport card. Anyone using the passport book or passport card reported as lost or stolen may be detained upon entry into the United States. Should you locate the U.S. passport book or passport card reported lost or stolen at a later time, report it as found and submit it for cancellation. It has been invalidated. You may not use that passport book or passport card for travel.PROTECT YOURSELF AGAINST IDENTITY THEFT!REPORT YOUR LOST OR STOLEN PASSPORT BOOK OR PASSPORT CARD!For more information or to report your lost or stolen passport book or passport card by phone, call NPIC or visit our website at .Your Social Security Number will be provided to Treasury, used in connection with debt collection and checked against lists of persons ineligible or potentially ineligible to receive a U.S. passport, among other authorized uses.ACTS OR CONDITIONS(If any of the below-mentioned acts or conditions have been performed by or apply to the applicant, the portion which applies should be lined out, and a supplementary explanatory statement under oath (or affirmation) by the applicant should be attached and made a part of this application.) I have not, since acquiring United States citizenship/nationality, been naturalized as a citizen of a foreign state; taken an oath or made an affirmation or other formal declaration of allegiance to a foreign state; entered or served in the armed forces of a foreign state; accepted or performed the duties of any office, post, or employment under the government of a foreign state or political subdivision thereof; made a formal renunciation of nationality either in the United States, or before a diplomatic or consular officer of the United States in a foreign state; or been convicted by a court or court martial of competent jurisdiction of committing any act of treason against, or attempting by force to overthrow, or bearing arms against, the United States, or conspiring to overthrow, put down, or to destroy by force, the government of the United States.Furthermore, I have not been convicted for a federal or state drug offense or convicted for "sex tourism" crimes statute and I am not the subject of an outstanding federal, state or local warrant of arrest for a felony; a criminal court order forbidding my departure from the United States; a subpoena received from the United States in a matter involving federal prosecution for, or grand jury investigation of, a felony.PRIVACY ACT STATEMENTAUTHORITIES: Collection of the information solicited on this form is authorized by Titles 8, 22, and 26 of the United States Code, and other applicable laws and regulations, including 22 USC 211a et seq.; 8 USC 1104; 26 USC 6039E, Section 236 of the Admiral James W. Nance and Meg Donovan Foreign Relations Authorization Act, Fiscal Years 2000 and 2001; Executive Order 11295 (August 5, 1966); and 22 CFR parts 50 and 51.PURPOSE: The primary purpose for soliciting the information is to establish citizenship, identity, and entitlement to issuance of a U.S. passport. ROUTINE USES: The information solicited on this form may be made available as a routine use to other government agencies and private contractors to assist the U.S. Department of State in adjudicating passport applications and requests for related services, and for law enforcement, fraud prevention, border security, counterterrorism, litigation activities, and administrative purposes. The information may be made available to foreign government agencies to fulfill passport control and immigration duties. The information may also be provided to foreign government agencies, international organizations and, in limited cases, private persons and organizations to investigate, prosecute, or otherwise address potential violations of law or to further the Secretary's responsibility for the protection of U.S. citizens and non-citizen nationals abroad. The information may be made available to the Department of Homeland Security and private employers for employment verification purposes. For a more detailed listing of the routine uses to which this information may be put see the Department of State's Prefatory Statement of Routine Uses relative to the Privacy Act (Public Notice 6290 of July 15, 2008) and the listing of routine users set forth in the System of Records Notices for Overseas Citizen Services Records (State-05) and Passport Records (State-26) published in the Federal Register.Your social security numbers will be provided to the U.S. Department of Treasury and failure to provide it may subject you to a penalty, as described in the Federal Tax Law provision. It also may be used for identification verification for passport adjudication and in connection with debt collection, among other purposes as authorized and generally described in this section. Providing your social security number and other information requested on this form otherwise is voluntary, but failure to provide the information requested on this form may result in processing delays or the denial of your U.S. passport application.CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Failure to provide the information requested on this form may result in Passport Services' refusal to accept your application or result in the denial of a U.S. passport.ELECTRONIC PASSPORT STATEMENTThe cover of the electronic passport book is printed with a special symbol representing the embedded chip. The symbol will appear in NOTICE TO APPLICANTS FOR OFFICIAL, DIPLOMATIC, OR NO-FEE PASSPORTSYou may use this application if you meet all of the provisions listed on Instruction Page 2, however you must CONSULT YOUR SPONSORING AGENCY FOR INSTRUCTIONS ON PROPER ROUTING PROCEDURES BEFORE FORWARDING THIS APPLICATION. Your completed passport will be released to your sponsoring agency for forwarding to you.Submit a recent, color photograph。
《中国公民因私出国(境)申请表》.doc
申请编号条形码中国公民因私出国（境）申请表以下内容由申请人填写（请用正楷字及兰黑色或黑色墨水水笔书写）：身份证号码姓名性别拼音姓拼音名民族出生日期年月日出生地婚姻状况政治面貌文化程度联系电话户口所在地址所属派出所家庭现住址邮政编码本人身份□国家工作人员□国有大中型企业中层以上管理人员□金融、保险系统人员□国有控股、参股企业中的国有股权代表□军人□其他人员服务处所职务职称服务处所地址联系电话前往国家或地区属第（）次申请因私出国（境）出国事由□定居□探亲□商务□劳务□留学□旅游□其他申请证件种类类别□普通护照首次申领□普通护照补发□普通护照换发□普通护照失效重新申领□普通护照变更加注普通护照变更加注类别：（）普通护照变更加注内容：（）普通护照换发、补发原因：（）原护照号码签发地有效期至年月日家庭主要成员称谓姓名出生日期工作单位、职务家庭住址本人简历（从参加工作开始填写）取证方式□邮政速递□到公安机关领取邮寄地址及邮政编码收件人姓名联系电话福建省公安厅出入境管理处监制此表不收费贴照片处近期正面免冠半身白色或淡蓝色背景彩色照片照片大小：48X33mm 头部宽度：21- 24mm 头部长度：28- 33mm特别声明：1、本人知道，凡属于登记备案的国家工作人员申办普通护照必须由单位出具意见，否则，由此造成的一切后果由本人承担；2、本申请表格所填内容正确无误，所提交的身份证明文件和照片真实有效。
如有虚假将承担法律责任。
申请人签名：年月日不满十六周岁的申请人，办理申请时，须由监护人陪同。
监护人须作出如下声明：本人是申请人的，依法拥有对申请人的监护权，同意申请人提出申请，本人的居民身份证号码：监护人签名：年月日。
护照申请表模板
护照申请表模板申请表格属性表格名称：护照申请表适用范围：对于申请个人护照或更新现有护照的申请者表格编号：PPA-001版本号：1.0申请表格填写说明该护照申请表格用于申请人对护照申请相关信息进行填写，请申请者仔细阅读并按照要求填写相关信息。
表格结构表格分为五个主要部分，详细说明如下：第一部分：个人信息在此部分中，申请人需要提供以下个人信息：1.姓名（中文拼音）2.性别3.出生日期4.国籍5.身份证件号码6.出生地7.现居住地址8.联系电话9.紧急联系人姓名及电话第二部分：护照信息在此部分中，申请人需要提供以下护照信息：1.原护照号码（如有）2.原护照有效期3.护照类型（普通/外交/公务等）4.申请护照类型（个人/团体）5.护照有效期要求第三部分：签证信息在此部分中，申请人需要提供以下签证信息：1.是否需要签证2.签证类型3.签证有效期第四部分：申请费用在此部分中，申请人需要提供以下费用信息：1.申请费用金额2.付款方式（现金/电汇/信用卡等）第五部分：申请人声明在此部分中，申请人需要签署对以下内容的声明：1.填写内容真实准确2.申请人对申请过程的了解和同意补充说明该护照申请表是必填项，申请人需准确填写所有相关信息。
若有任何不实填写或提供错误信息，将可能导致申请被拒绝或延迟处理。
申请人应仔细核对所填写的信息，并在签署申请人声明前再次确认。
申请人声明我谨在此声明，我已仔细阅读并理解了护照申请表格的内容，并且我保证所填写的所有信息都是真实、准确和完整的。
我对申请护照所需的程序、费用和时间要求都有所了解，并同意遵守相关规定和要求。
签名：______________________日期：______________________注意事项1.请使用黑色或蓝色墨水笔填写表格，不要使用铅笔或红色字迹。
2.请勿使用涂改液或修正带修改填写的内容，如需更正，请在错误处打一个“×”，并在旁边重新填写。
3.请确保表格填写清晰、字迹工整，避免出现模糊或不易辨认的情况。
中国公民出入境证件申请表(样表)
仅探亲类签
台湾亲属姓名_________，性别____，出生日期_______，与申请人关系_____，
注填写 台湾身份证号码___________________，旅行证件号码____________________。
取证 方式
□前往公安机关出入境管理部门领取
□邮寄送达
邮寄 地址
深圳市 xx 区 xx 路 xx 号 xx 花园 xx 栋 xx 号
Байду номын сангаас
在深亲属姓名
在深亲属身份证号
与在深亲属关系 □父母 □配偶 □子女
在深亲属类别 □深户 □非深户就业人员 □非深户大学生
□首次申领
□补发 □换发
□失效重新申领
□加注
□ 普通 护照
前往地
加注 内容
□曾持照加注 （曾持护照号码： □曾用名加注 （曾用名：
出境 事由
□旅行 □商务
□探亲 □定居
）
） □姓名加注 （姓名：
√3 个月一次
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中国公民出入境证件申请表
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（请用黑色签字笔或钢笔书写，并在相应选项内打“√”）：
美国公民护照申请表格 DS-11模版
FAILURE TO PROVIDE INFORMATION REQUESTED ON THIS FORM, INCLUDING YOUR SOCIAL SECURITY NUMBER,MAY RESULT IN SIGNIFICANT PROCESSING DELAYS AND/OR THE DENIAL OF YOUR APPLICATION.U.S. PASSPORT APPLICATIONWHAT TO SUBMIT WITH THIS FORM:1.PROOF OF U.S. CITIZENSHIP: Evidence of U.S. citizenship AND a photocopy of the front (and back, if there is printed information) must be submitted with your application. The photocopy must be on 8 ½ inch by 11 inch paper, black and white ink, legible, and clear. Evidence that is not damaged, altered,or forged will be returned to you. Note: Lawful permanent resident cards submitted with this application will be forwarded to U.S. Citizenship and Immigration Services, if we determine that you are a U.S. citizen.2.PROOF OF IDENTITY: You must present your original identification AND submit a photocopy of the front and back with your passport application.3.RECENT COLOR PHOTOGRAPH: Photograph must meet passport requirements – full front view of the face and 2x2 inches in size.4.FEES: Please visit our website at for current fees.HOW TO SUBMIT THIS FORM:Complete and submit this application in person to a designated acceptance agent: a clerk of a federal or state court of record or a judge or clerk of a probate court accepting applications; a designated municipal or county official; a designated postal employee at an authorized post office; an agent at a passport agency (by appointment only); or a U.S. consular official at a U.S. Embassy or Consulate, if abroad. To find your nearest acceptance facility, visit or contact the National Passport Information Center at 1-877-487-2778.Follow the instructions on Page 2 for detailed information to completion and submission of this form.If you are 16 years of age or older : Your U.S. passport will be valid for 10 years from the date of issue except where limited by the Secretary of State to a shorter period.If you are under 16 years of age : Your U.S. passport will be valid for five years from the date of issue except where limited by the Secretary of State to a shorter period.PASSPORT VALIDITY LENGTHPLEASE DETACH AND RETAIN THIS INSTRUCTION SHEET FOR YOUR RECORDS● The passport application fee, security surcharge, and expedite fee may be paid in any of the following forms: Checks (personal, certified, or traveler's) with the applicant's full name and date of birth printed on the front; major credit card (Visa, Master Card, American Express, and Discover); bank draft or cashier's check; money order (U.S. Postal, international, currency exchange), or if abroad, the foreign currency equivalent, or a check drawn on a U.S. bank. All fees should be payable to the "U.S. Department of State" or if abroad, the appropriate U.S. Embassy or U.S. Consulate. When applying at a designated acceptance facility, the execution fee will be paid separately and should be made payable to the acceptance facility. NOTE: Some designated acceptance facilities do not accept credit cards as a form of payment.● For faster processing , you may request expedited service. Please include the expedite fee in your payment. Our website contains updated information regarding fees and processing times for expedited service. Expedited service is only available for passports mailed in the United States and Canada.● OVERNIGHT DELIVERY SERVICE is only available for passport book mailings in the United States. Please include the appropriate fee with your payment.● An additional fee will be charged when, upon your request, the U.S. Department of State verifies issuance of a previous U.S. passport or Consular Report of Birth Abroad because you are unable to submit evidence of U.S. citizenship.● For applicants with U.S. government or military authorization for no-fee passports , no fees are charged except the execution fee when applying at a designated acceptance facility. PROOF OF U.S. CITIZENSHIPYou may submit items such as the following containing your signature AND a photograph that is a good likeness of you: previous or current U.S. passport book; previous or current U.S. passport card; driver's license (not temporary or learner's license); Certificate of Naturalization; Certificate of Citizenship;military identification; or federal, state, or municipal government employee identification card. Temporary or altered documents are not acceptable.You must establish your identity to the satisfaction of the acceptance agent and Passport Services. We may ask you to provide additional evidence to establish your identity. If you have changed your name, please see for instructions.IF YOU CANNOT PROVIDE DOCUMENTARY EVIDENCE OF IDENTITY as stated above, you must appear with an IDENTIFYING WITNESS, who is a U.S.citizen, non-citizen U.S. national, or permanent resident alien that has known you for at least two years. Your witness must prove his or her identity and complete and sign an Affidavit of Identifying Witness (Form DS-71) before the acceptance agent. You must also submit some identification of your own.Submit a color photograph of you alone, sufficiently recent to be a good likeness of you (taken within the last six months), and 2x2 inches in size. The image size measured from the bottom of your chin to the top of your head (including hair) should not be less than 1 inch, and not more than 1 3/8 inches. The photograph must be in color, clear, with a full front view of your face. The photograph must be taken with a neutral facial expression (preferred) or a natural smile, and with both eyes open and be printed on photo quality paper with a plain light (white or off-white) background. The photograph must be taken in normal street attire, without a hat, or head covering unless a signed statement is submitted by the applicant verifying that the hat or head covering is part of recognized, traditional religious attire that is customarily or required to be worn continuously when in public or a signed doctor's statement is submitted verifying the item is used daily for medical purposes. Headphones, "bluetooth", or similar devices must not be worn in the passport photograph. Glasses or other eyewear are not acceptable unless you provide a signed statement from a doctor explaining why you cannot remove them due to medical reasons (e.g.,during the recovery period from eye surgery). Any photograph retouched so that your appearance is changed is unacceptable. A snapshot, most vending machine prints, hand-held self portraits, and magazine or full-length photographs are unacceptable. A digital photo must meet the previously stated qualifications, and will be accepted for use at the discretion of Passport Services. Visit our website at for details and information.FEES ARE LISTED ON OUR WEBSITE AT . BY LAW, THE PASSPORT FEES ARE NON-REFUNDABLE.PROOF OF IDENTITYCOLOR PHOTOGRAPHFEESAPPLICANTS BORN IN THE UNITED STATES: Submit a previous U.S. passport or certified birth certificate. Passports that are limited in validity will need to be supplemented by other evidence. A birth certificate must include your full name, date and place of birth, sex, date the birth record was filed, the seal or other certification of the official custodian of such records (state, county, or city/town office), and the full names of your parent(s).- If the birth certificate was filed more than 1 year after the birth : It must be supported by evidence described in the next paragraph.- If no birth record exists : Submit a registrar's notice to that effect. Also, submit a combination of the evidence listed below, which should include your given name and surname, date and/or place of birth, and the seal or other certification of the office (if customary), and the signature of the issuing official. ● A hospital birth record;● An early baptismal or circumcision certificate;● Early census, school, medical, or family Bible records;● Insurance files or published birth announcements (such as a newspaper article); and● Notarized affidavits (or DS-10, Birth Affidavit) of older blood relatives having knowledge of your birth may be submitted in addition to some of the records listed above.APPLICANTS BORN OUTSIDE THE UNITED STATES : Submit a previous U.S. passport, Certificate of Naturalization, Certificate of Citizenship, Consular Report of Birth Abroad, or evidence described below:- If you claim citizenship through naturalization of parent(s): Submit the Certificate(s) of Naturalization of your parent(s), your foreign birth certificate (and official translation if the document is not in English), proof of your admission to the United States for permanent residence, and your parents'marriage/certificate and/or evidence that you were in the legal and physical custody of your U.S. citizen parent, if applicable.- If you claim citizenship through birth abroad to at least one U.S. citizen parent : Submit a Consular Report of Birth (Form FS-240), Certification of Birth (Form DS-1350 or FS-545), or your foreign birth certificate (and official translation if the document is not in English), proof of U.S. citizenship of your parent, your parents' marriage certificate, and an affidavit showing all of your U.S. citizen parents' periods and places of residence/physical presence in the United States and abroad before your birth.- If you claim citizenship through adoption by a U.S. citizen parent(s): Submit evidence of your permanent residence status, full and final adoption , and your U.S. citizen parent(s) evidence of legal and physical custody. (NOTE : Acquisition of U.S. citizenship for persons born abroad and adopted only applies if the applicant was born on or after 02/28/1983.)ADDITIONAL EVIDENCE: You must establish your citizenship to the satisfaction of the acceptance agent and Passport Services. We may ask you to provide additional evidence to establish your claim to U.S. citizenship. Visit for details.NOTE REGARDING MAILING OF YOUR PASSPORT(S)Passport Services will not mail a U.S. passport to a private address outside the United States or Canada. If you do not live at the address listed in the "mailing address", then you must put the name of the person and mark it as "In Care Of" in item # 8. If your mailing address changes prior to receipt of your new passport, please contact the National Passport Information Center.If you choose to provide your email address in Item #6 on this application, Passport Services may use that information to contact you in the event there is a problem with your application or if you need to provide information to us.You may receive your newly issued passport book and/or card and your returned citizenship evidence in two separate mailings. If you are applying for both a U.S. passport book and passport card, you may receive three separate mailings; one with your returned citizenship evidence, one with your newly issued passport book, and one with your newly issued passport card.FEDERAL TAX LAWSection 6039E of the Internal Revenue Code (26 U.S.C. 6039E) and 22 U.S.C 2714a(f) require you to provide your Social Security number (SSN), if you have one, when you apply for or renew a U.S. passport. If you have never been issued a SSN, you must enter zeros in box #5 of this form. If you are residing abroad, you must also provide the name of the foreign country in which you are residing. The U.S. Department of State must provide your SSN and foreign residence information to the U.S. Department of the Treasury. If you fail to provide the information, your application may be denied and you are subject to a $500 penalty enforced by the IRS. All questions on this matter should be referred to the nearest IRS office.NOTICE TO CUSTOMERS APPLYING OUTSIDE A DEPARTMENT OF STATE FACILITYIf you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your account for the amount of the check. The debit from your account will usually occur within 24 hours and will be shown on your regular account statement.You will not receive your original check back. We will destroy your original check, but we will keep the copy of it. If the EFT cannot be processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT cannot be completed because of insufficient funds, we may try to make the transfer up to two times, and we will charge you a one-time fee of $25, which we will also collect by EFT.FEE REMITTANCEPassport service fees are established by law and regulation (see 22 U.S.C. 214, 22 C.F.R. 22.1, and 22 C.F.R. 51.50-56), and are collected at the time you apply for the passport service. If the Department fails to receive full payment of the applicable fees because, for example, your check is returned for any reason or you dispute a passport fee charge to your credit card, the U.S. Department of State will take action to collect the delinquent fees from you under 22 C.F.R. Part 34, and the Federal Claims Collection Standards (see 31 C.F.R. Parts 900-904). In accordance with the Debt Collection Improvement Act (Pub.L. 104-134), if the fees remain unpaid after 180 days and no repayment arrangements have been made, the Department will refer the debt to the U.S. Department of Treasury for collection. Debt collection procedures used by U.S. Department of Treasury may include referral of the debt to private collection agencies, reporting of the debt to credit bureaus, garnishment of private wages and administrative offset of the debt by reducing, or withholding eligible federal payments (e.g., tax refunds, social security payments, federal retirement, etc.) by the amount of your debt, including any interest penalties or other costs incurred. In addition, non-payment of passport fees may result in the invalidation of your passport. An invalidated passport cannot be used for travel.USE OF SOCIAL SECURITY NUMBERYour Social Security number will be provided to U.S. Department of Treasury, used in connection with debt collection and checked against lists of persons ineligible or potentially ineligible to receive a U.S. passport, among other authorized uses.NOTICE TO APPLICANTS FOR OFFICIAL, DIPLOMATIC, OR NO-FEE PASSPORTSYou may use this application if you meet all of the provisions listed on Instruction Page 2; however, you must CONSULT YOUR SPONSORING AGENCY FOR INSTRUCTIONS ON PROPER ROUTING PROCEDURES BEFORE FORWARDING THIS APPLICATION. Your completed passport will be released to your sponsoring agency for forwarding to you.PROTECT YOURSELF AGAINST IDENTITY THEFT!REPORT YOUR LOST OR STOLEN PASSPORT BOOK OR PASSPORT CARD!For more information regarding reporting a lost or stolen U.S. passport book or passport card (Form DS-64), or to determine your eligibility for a passport renewal (Form DS-82), call NPIC at 1-877-487-2778 or visit .NOTICE TO U.S. PASSPORT CARD APPLICANTSThe maximum number of letters provided for your given name (first and middle) on the U.S. passport card is 24 characters. The 24 characters may be shortened due to printing restrictions. If both your given names are more than 24 characters, you must shorten one of your given names you list on item 1 of this form.U.S. passports, either in book or card format, are only issued to U.S. citizens or non-citizen U.S. nationals. Each person must obtain his or her own U.S. passport book or U.S. passport card. The passport card is a U.S. passport issued in card format. Like the traditional U.S. passport book, it reflects the bearer's origin, identity, and nationality, and is subject to existing passport laws and regulations. Unlike the U.S. passport book, the U.S. passport card is valid only for entry at land border crossings and sea ports of entry when traveling from Canada, Mexico, the Caribbean, and Bermuda. The U.S. passport card is not valid for international air travel.ELECTRONIC PASSPORT STATEMENTThe cover of the electronic passport book is printed with a special symbol representing the embedded chip. The symbol will appear inACTS OR CONDITIONSIf any of the below-mentioned acts or conditions have been performed by or apply to the applicant, the portion which applies should be lined out, and a supplementary explanatory statement under oath (or affirmation) by the applicant should be attached and made a part of this application.I have not, since acquiring United States citizenship/nationality, been naturalized as a citizen of a foreign state; taken an oath or made an affirmation or other formal declaration of allegiance to a foreign state; entered or served in the armed forces of a foreign state; accepted or performed the duties of any office, post, or employment under the government of a foreign state or political subdivision thereof; made a formal renunciation of nationality either in the United States, or before a diplomatic or consular officer of the United States in a foreign state; or been convicted by a court or court martial of competent jurisdiction of committing any act of treason against, or attempting by force to overthrow, or bearing arms against, the United States, or conspiring to overthrow, put down, or to destroy by force, the government of the United States. Furthermore, I have not been convicted of a federal or state drug offense or convicted of a "sex tourism" crimes statute, and I am not the subject of an outstanding federal, state, or local warrant of arrest for a felony; a criminal court order forbidding my departure from the United States; a subpoena received from the United States in a matter involving federal prosecution for, or grand jury investigation of, a felony.PRIVACY ACT STATEMENTAUTHORITIES: Collection of this information is authorized by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 26 U.S.C. 6039E, 22 U.S.C. 2714a(f), Section 236 of the Admiral James W. Nance and Meg Donovan Foreign Relations Authorization Act, Fiscal Years 2000 and 2001; Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51.PURPOSE: We are requesting this information in order to determine your eligibility to be issued a U.S. passport. Your Social Security number is used to verify your identity.ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State-05, Overseas Citizen Services Records and State-26, Passport Records.DISCLOSURE: Providing information on this form is voluntary. Be advised, however, that failure to provide the information requested on this form may cause delays in processing your U.S. passport application and/or could result in the refusal or denial of your application.Failure to provide your Social Security number may result in the denial of your application (consistent with 22 U.S.C. 2714a(f)) and may subject you to a penalty enforced by the Internal Revenue Service, as described in the Federal Tax Law section of the instructions to this form. Your Social Security number will be provided to the Department of the Treasury and may be used in connection with debt collection, among other purposes authorized and generally described in this section.PAPERWORK REDUCTION ACT STATEMENTPublic reporting burden for this collection of information is estimated to average 85 minutes per response, including the time required for searching existing data sources, gathering the necessary data, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Legal Affairs and Law Enforcement Liaison, 44132 Mercure Cir, P.O. Box 1227, Sterling, Virginia 20166-1227DS-11 06-2016Attach a color photograph taken within the last six months18.Travel Plans Departure Date (mm/dd/yyyy)Return Date (mm/dd/yyyy)Countries to be Visited Apartment/Unit 19.Permanent Address - If P.O. Box is listed under Mailing Address or if residence is different from Mailing Address.Street/RFD # or URB (No P.O. Box )13.Occupation (if age 16 or older)14.Employer or School (if applicable)Home Cell Work 12.Additional Contact Phone NumberMother/Father/Parent - First & Middle Name Last Name (at Parent's Birth) Date of Birth (mm/dd/yyyy) Place of Birth 10.Parental Information Male FemaleYesNo U.S. Citizen?Sex Date of Birth (mm/dd/yyyy)Name of Applicant (Last, First, & Middle)--Mother/Father/Parent - First & Middle Name Last Name (at Parent's Birth) Date of Birth (mm/dd/yyyy) Place of Birth Male Female YesNo U.S. Citizen?Sex ----If yes, complete the remaining items in #11. Date of Marriage(mm/dd/yyyy)11.Have you ever been married?Full Name of Current Spouse or Most Recent Spouse Date of Birth (mm/dd/yyyy)Have you ever been widowed or divorced?Place of BirthYes No Widow/Divorce Date (mm/dd/yyyy)Yes NoYesNo U.S. Citizen?--15.Height 16. Hair Color 17. Eye Color City Zip CodeState 21.Have you ever applied for or been issued a U.S. Passport Book or Passport Card?Name as printed on your most recent passport book Yes No If yes, complete the remaining items in #21.PLEASE DO NOT WRITE BELOW THIS LINE - FOR ISSUING OFFICE ONLY 20.Emergency Contact - Provide the information of a person not traveling with you to be contacted in the event of an emergency.Name Address: Street/RFD # or P.O. Box Apartment/UnitCity State Zip CodePhone Number Relationship Name as printed on your most recent passport cardStatus of your most recent passport book:Submitting with application Stolen LostIn my possession (if expired )Status of your most recent passport card:Submitting with application Stolen Lost In my possession (if expired )Most recent passport book number Most recent passport book issue date (mm/dd/yyyy)Most recent passport card number Most recent passport card issue date (mm/dd/yyyy)*DS 11 C 09 2013 2 *Name as it appears on citizenship evidenceBirth Certificate SR CR City Filed:Issued:Passport C/R S/R Per PIERS #/DOI:Attached:P/C of ID DS-5520DS-3053DS-64DS-5525PAW DS-71NPIC IRL Citz W/S Report of Birth Filed/Place:Nat. / Citz. Cert. USCIS USDC Date/Place Acquired:A#Other:P/C of Citz 姓名出生年月日爸爸或妈妈的名 姓（父母的信息）月日年出生地（CHINA)爸爸或妈妈的名姓月日年出生地（CHINA)B lack Black (如在国外更换护照需要填写，在中国则不需要填写）紧急联系人姓名地址X X X 护照姓名护照号码护照签发日期。
公民出入境证件申请表
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本人谨此声明：
持证人希望免登记使用港澳地区自助查验通道，同意香港入境事务处、澳门治安警察局在口岸查验工作中读取持证人电子往来港澳通行证中的指纹模板信息。
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公民出入境证件申请表
中国公民出入境证件申请表
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姓名
拼音姓拼音名Fra bibliotek身份证号码
中华人民共和国护照旅行证申请表
我保证以上内容全部属实，且未加入外国国籍，如有隐瞒，由此引起的一切法律责任均由本人承 担。
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（表格背页）
申请中国护照/旅行证须知
一、申请上述证件时，本人须亲自到大使馆或大使馆领事官员现场办公时当面办理，并用黑色签 字笔，正楷、如实、完整、清晰填写《中华人民共和国护照/旅行证申请表》一份。请逐项填写， 勿遗漏。 二、递交3张2寸正面免冠近照。照片为光面相纸，尺寸48mm×33mm, 背景为白色或淡蓝色， 人 物面部清晰，五官露出，光线均匀，头像长度在28mm至33mm之间，宽度在21mm至24mm之间。请勿 用回形针夹照片或在照片背面写名字。 三、提交中国护照原件、护照资料页及澳有效签证复印件各一份。 四、其他补充材料 （一）在澳出生的儿童，父母均为中国公民且未获得澳永久居留权，该儿童可申请中国护照；如 父母一方为澳大利亚公民或已获澳永居，该儿童已具有澳籍，不能申请中国护照。儿童申请护照， 需由父母带至本馆，交验父母双方有效护照、结婚证书、儿童出生证及上述文件的复印件；非婚 生儿童父母，需提供其共同生活的相关证明并递交复印件。 （二）护照遗失，请出示警察局出具的报失单，填写《中国护照遗失报告书》。 （三）护照损毁且无法提供残件，须提供一份情况说明。 五、未持有效《港澳同胞回乡证》的港澳同胞或未持有效《台湾居民来往大陆通行证》的台湾同 胞，如需前往中国大陆，可申请《中华人民共和国旅行证》。 六、因技术原因，新发、换发、补发护照均无加急服务，办照时间为三周左右，护照补发请等待 通知领取。旅行证办理时间为四个工作日。 七、费用表(澳元)
护照申请表模板
护照申请表模板
姓名（英文）：
性别：
出生日期（年/月/日）：
国籍：
出生地：
现居住地（英文）：
联系电话：
电子邮箱：
一、个人信息
1.1 护照种类：
1.2 申请原因：
1.3 申请日期：
1.4 边防口岸选择：
二、个人照片
请贴上一张2英寸（51mm x 51mm）的正面、免冠彩色照片，背景为白色。
三、身份信息
3.1 证件号码：
3.2 签发地点：
3.3 签发日期：
3.4 公民身份证号码：3.5 姓名拼音：
3.6 性别：
3.7 出生日期：
3.8 出生地点：
3.9 婚姻状况：
3.10 职业：
四、联系信息
4.1 家庭住址：
4.2 联系电话：
4.3 电子邮箱：
4.4 紧急联系人姓名：
4.5 紧急联系人电话：
五、背景信息
5.1 以往持有其他国家护照情况：
5.2 过去十年内是否曾申请过、持有、被拒绝、撤销或者注销过中国护照/旅行证：
5.3 过去十年内是否曾申请过其他国家的签证：
5.4 过去十年内是否曾有被其他国家拒签的情况：
5.5 过去十年内是否曾被其他国家驱逐出境：
5.6 过去十年内是否曾有刑事犯罪记录：
5.7 过去十年内是否曾参军或从事军事相关工作：
六、意愿声明
我声明以上填写的信息是准确、完整和真实的。
我明白，如果信息不准确、不完整或不真实，可能导致申请被拒绝或护照无效。
签名：
日期：。
护照申请表模板
护照申请表模板申请人须知：1. 本表适用于中国公民申请护照，填写时请用黑色或蓝色墨水签字笔，清晰书写。
如有涂改，请用正确方式修正错误。
2. 所有填写内容需准确无误，如有虚假信息，将受到法律追究。
3. 所有必填项目均需填写完整，如有不适用的项目，请填写“N/A”。
个人信息1. 姓（拼音）： _________________________2. 名（拼音）： _________________________3. 中文姓名： _________________________4. 曾用名（如有）： _________________________5. 性别： _________________________6. 出生日期（年/月/日）： _________________________7. 国籍： _________________________8. 民族： _________________________9. 婚姻状况： _________________________10. 出生地： _________________________11. 宗教信仰： _________________________12. 职业： _________________________13. 现住址： _________________________14. 联系电话： _________________________15. 电子邮件： _________________________16. 学历： _________________________17. 签发地： _________________________旅行计划18. 预计离境日期（年/月/日）： _________________________19. 预计归国日期（年/月/日）： _________________________家庭成员20. 父亲姓名： _________________________21. 父亲国籍： _________________________22. 母亲姓名： _________________________23. 母亲国籍： _________________________紧急联系人（非父母）24. 姓名： _________________________25. 与申请人的关系： _________________________26. 联系电话： _________________________签发要求27. 护照类型：- 普通护照（P）- 公务护照（S）- 公派护照（S1）- 旅行证（L）照片要求请携带一张符合以下要求的护照照片：- 尺寸为33mm x 48mm；- 照片底色为纯白色，无纹理；- 头部居中，面部清晰可见；- 不戴帽子、耳环等遮挡物；- 若佩戴眼镜，请确保不反光，不遮挡眼部。
护照申请表模板
护照申请表模板姓名：性别：国籍：出生地：出生日期：婚姻状况：住址：联系电话：电子邮箱：教育程度：职业：申请签发护照类型（普通/外交/公务/海员）：申请人注意事项：1. 请填写所有必填字段，并确保所填信息准确无误。
2. 所填写的信息必须与提供的身份证明文件一致。
3. 请使用中文或英文填写申请表，确保清晰可读。
4. 所有申请人（包括儿童）均须填写个人独立的申请表。
5. 请勿使用涂改液或其他杂物修改申请表，如有错误请重新填写。
6. 申请人须自愿提供申请表上所需的个人信息，以供护照签发机关核实。
个人信息：1. 姓名：__________________（正楷填写，请注意姓和名的空隙）2. 性别：__________________3. 国籍：__________________4. 出生地：__________________5. 出生日期：__________________（年/月/日）6. 婚姻状况：__________________（填写已婚/未婚/离异/丧偶）7. 住址：__________________8. 联系电话：__________________9. 电子邮箱：__________________10. 教育程度：__________________（填写最高教育程度）11. 职业：__________________申请护照类型：申请签发护照类型（普通/外交/公务/海员）：__________________（在适用选项前打勾）材料清单：请在下面列出您提交的文件清单，并在相应的方框内打勾以示确认。
- [ ] 身份证明文件（身份证/驾驶证/户口本等）- [ ] 出生证明文件（出生证明/社会保障卡等）- [ ] 图片（符合规定的护照照片，尺寸和要求请咨询相关机构）- [ ] 支付凭证（缴纳护照申请费用的凭证副本）申请人承诺：我在此承诺，并保证所提供的信息和文件是准确的和真实的。
如有虚假陈述或提供不实资料，我将自愿承担相应责任。
中华人民共和国护照申请表
中华人民共和国护照申请表
注意：1、根据《中华人民共和国国籍法》，定居国外的中国公民，自愿加入或取得外国国籍的，即自动丧失中国国籍，不能再申请中国护照。
2、请用正楷填写，内容应如实、完整、清楚，否则可能被拒绝受理；3、带“□”的项目，请按实际情况选择（“✈”或“ ”）并填写；4、申请人应亲自到馆申请并签名；未成年人可由监护人代签。
请继续填写表格背面内容并签名➢
领事机关专用
我谨声明，以上内容全部属实。
如有不实，由此引起的一切责任，均由我本人承担。
申请人中文签名：申请日期：年月日（如系监护人代签，请说明与申请人关系：）。
护照申请表样本
护照申请表样本[国家名称][国家旗帜]机密护照申请表姓：________________名：________________国籍：________________性别：________________出生日期：__________年 ______月 ______日出生地：________________护照申请号码：________________逗留期限：__________年 ______月 ______日签发日期：__________年 ______月 ______日护照类型：________________联系方式：电话号码：________________电子邮件：________________住址：________________护照信息：1. 照片：- 请在此处粘贴一张2英寸 x 2英寸正面彩色照片- 照片要求：背景为白色，脸部清晰可见，无眼镜及其他遮挡2. 父母信息：- 父亲姓名：________________- 母亲姓名：________________3. 婚姻状况：- 婚姻状态：________________- 配偶姓名：________________4. 子女信息：- 子女数量：______________- 子女姓名及出生日期：________________5. 职业信息：- 职业：________________- 工作单位：______________6. 联系人信息：- 联系人姓名：________________- 联系人关系：________________- 联系人地址：________________- 联系人电话：________________- 联系人电子邮件：________________7. 其他信息：- 是否曾被拒签过：________________- 是否曾被驱逐出境：________________- 是否有犯罪记录：________________- 是否在其他国家持有国籍：________________申请人声明：我在此确认以上信息的准确性，并同意在护照签发后遵守我所访问国家的法律法规。
护照申请表模板
中华人民共和国普通护照申领表以下内容由申请人填写（请用正楷字及蓝黑色或黑色墨水水笔书写，其他颜色或圆珠笔填写不予受理）：身份证号码姓名性别拼音姓拼音名民族出生日期年月日出生地婚姻状况文化程度住宅及移动电话家庭住址户籍所属派出所本人身份□国家工作人员□国有大中型企业中层以上管理人员□金融、保险系统人员□国有控股、参股企业中的国有股权代表□军人□其他人员工作单位单位电话拟前往国家属第（）次申请因私出国出国事由□定居□探亲□商务□劳务□留学□旅游□其他（）申请类别□首次申领□补发□换发□失效重新申领□变更加注普通护照变更加注类别：普通护照变更加注内容：普通护照换发、补发原因：原护照号码签发地有效期至年月日直系亲属和近亲属称谓姓名年龄工作单位、职务家庭住址本人简历取证方式□邮政速递□到公安机关领取邮寄地址及邮政编码收件人姓名联系电话申请编号条形码贴照片处近期正面免冠半身白色或淡蓝色背景彩色照片照片大小：48X33mm头部宽度：21- 24mm头部长度：28- 33mm特别声明：1、本人知道，凡属于登记备案的国家工作人员申办普通护照必须由单位出具意见，否则，由此造成的一切后果由本人承担；2、本申请表格所填内容正确无误，所提交的身份证明文件和照片真实有效。
如有虚假将承担法律责任。
申请人签名：年月日不满十六周岁的申请人，办理申请时，须由监护人陪同。
监护人须作出如下声明：本人是申请人的，依法拥有对申请人的监护权，同意申请人提出申请，本人的身份证件号码：①②监护人签名：①②年月日。
中国公民办理因私护照申请表
公安部出入境管理局监制（此表不收费，可复印）
所属派出所
家庭现住址
联系电话
服务处所
职务
服务处所地址
联系电话
本人
身份
□国家工作人员□国有大中型企业中层以上管理人员□金融、保险系统人员
□国有控股、参股企业中的国有股权代表□军人□其他人员
前往国家
属第( )次申请因私出国
出国事由
□定居□探亲□商务□劳务□留学□旅游□其他
申请
证件
种类
类别
□普通护照首次申领□普通护照补发□普通护照换发□普通护照失效重新申领
中国公民办理因私护照申请表
以下内容由申请人填写，填写时请您阅读表格背面的“填表须知”，并按“须免冠半身白色或淡蓝色背景彩色照片
照片大小：48×33mm
头部宽度：21-24mm
头部长度：28-33mm
姓
名
性别
拼音姓
拼音名
民族
出生日期
出生地
政治面貌
户口所在地
6、不予签发护照的情形：（1）不具有中华人民共和国国籍的；（2）无法证明身份的；（3）在申请过程中弄虚作假的；（4）被判处刑罚正在服刑的；（5）人民法院通知有未了结民事案件不能出境的；（6）属于刑事案件被告人或者犯罪嫌疑人的；（7）国务院有关主管部门认为出境后将对国家安全造成危害或者对国家利益造成重大损失的。
2、申请表中有“□”的栏目，请在相应项划“√”；
3、“政治面貌”栏如是“中国共产党员”，请填写“中共党员”；
4、“家庭主要成员”栏未婚填写父母（已故在“住址”栏填“已故”），已婚填配偶和子女；
(整理)护照申请表-背面
7、此申请表所填内容真实正确无误，所提交的申请材料真实有效，本人愿意接受公安机关出入境管理部门的询 问。如本申请表、所提交的申请材料以及有关答复存在虚假情形，本人愿意承担法律责任。
年月日 注意：十六周岁的界定以申请人向公安机关出入境管理部门递交本表之日起为准。如具有监护权的系单位，该
单位应当在签名栏加盖本单位公章。
申请人声明
本人现谨此声明： 1、本人具有中华人民共和国国籍。 2、本人知道，如本人系登记备案的国家工作人员，在申办普通护照时应当按规定提交本人所属工作单位或者上
级主管单位按照人事管理权限审批后出具的同意出境的证明。 3、本人知道，申请换发或者补发普通护照时，原普通护照将被宣布作废。 4、本人知道，本人提交的指纹信息将存储于普通护照中。十六周岁以下申请人可以不采集指纹。 5、本人知道，以下签名应为本人的真实姓名，且将扫描打印至本人普通护照的资料页中。出入境时，边防检查
申请人签名：
（请在民警受理时当面签署， 此前签署无效）
年月日
注意：签名原则上须以规范汉字签名，少数民族公民可以依照居民身份证上的少数民族语言姓名签名。签名应 当横向书写，且须在矩形框内，不得压线或倾斜，各字之间距离不超过半个字。
注意事项
1、根据国务院价格行政部门和财政部门的规定，普通护照的收费标准为：
（1）首次申请 （2）换发普通护照 （3）原普通护照失效重新申请
精品（文4档）因原普通护照被盗、损毁补发普通护照 （5）因原普通护照丢失补发普通护照 （6）加注 （7）本申请表
200 元/本； 220 元/本（含换发加注费） 220 元/本（含曾持照加注费）
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本人签名：日期：年月日联系：
下列人员需按干部管理权限由相关单位出具意见
1、各级党政机关、人大、政协、人民法院、人民检察院、人民团体在职的国家工作人员，离（退）休的厅（局）级以上领导干部；
2、事业单位在职的（县）处级以上领导干部；
□定居□探亲□访友□自费留学□公派留学□商务□劳务□个人旅游
□团队旅游□继承财产□结婚□其他非公务活动( )
申请类别
□首次申请□护Байду номын сангаас过期重领（请将旧护照上交）
前往国家
原护照
有效期至
年月日
签发地
您是否需要通过邮政特快专递方式领取护照？如果需要请在申请时与窗口工作人员联系
年龄在十四周岁以下的申请人申办护照需由父母或法定监护人作如下声明和签署：
□已核对申请人的人口信息
签名：
年月日
省厅意见
审批意见：
签名：
年月日
护照
签发日期
6、国有企业中层以上管理人员，国有控股、参股企业中的国有股权代表；
7、所在单位认为有必要列入登记管理的人员。
申请表中所填写容是否属实，是否同意该人申请因私护照？
单位意见：负责人签名：（单位公章）
联系：年月日
本人保证申请表中各栏所填容及所提交的明文件和照片真实无假，如有任何虚假，愿负法律责任。
申请人签名：
3、列入各级政府人才培养工程的培养人选，享受政府特殊津贴的人员，国家、省有突出贡献的中青年科技人员，具有副高级以上专业技术职务任职资格的专业技术人员；
4、银行、证券、信托、保险等金融机构中层以上干部和重要岗位的人员；
5、承担、参与涉及国家政治、经济、科技、商业、安全等秘密单位的重要岗位，以及离开涉密岗位仍在脱密期的人员；
中国公民因私出国护照申请表
贴照片处
近期正面免冠2寸彩照，白色背景
相片大小：48mm×33 mm
头部宽度：21-24mm
头部长度：28-33mm
中文姓
中文名
性别
拼音姓
拼音名
婚姻状况
出生日期
年月日
出生地
文化程度
职务(级别或职称)
工作单位
单位
户口所在地
省市县(市、区)
户口所属派出所
家庭住址
家庭或手机
申请事由
年月日
档案：
（户口簿及复印件粘贴处）
受理意见：
□已面见申请人，并且核对申请人的有关证件及相关证明材料原件
□已核查申请人的人口信息
□已核对不准出国（境）人员信息
□已核查申请人的历史申请信息
同意受理该申请。
签名：
年月日
县(市)审核意见：
签名：
年月日
审批意见：
□已核对国家工作人员登记备案信息
□已核对不准出国(境)人员报备信息