FOR PASSPORT OFFICE USE ONLY

[ ]- REGULAR [ ] - OFFICIAL [ ] - DIPLOMATIC [ ] - EXTENSION [ ] - AMENDMENT> [ ] - NEW PASSPORT

PASSPORT NUMBER:_________________________ ISSUANCE DATE:__________________ EXPIRATION DATE:________________

Receipt No.:__________________ Date paid:______________ Issued by:_____________/______________ ENTERED:_________________

DO NOT WRITE ABOVE THIS LINE

PALAU PASSPORT OFFICE

Ministry of State

P. O. Box 100 Koror, Republic of Palau 96940

Tel No. 680-488-6330/8092 Fax No. 680-488-2443 Email: [email protected]

Web: www.bdarop.com/www.palauembassy.com

PASSPORT APPLICATION

HOW TO APPLY FOR A PASSPORT OF THE REPUBLIC OF PALAU

Passports of the Republic of Palau are issued only to citizens of the Republic of Palau. Each person must obtain his or her own passport.

IF YOU ARE A FIRST TIME APPLICANT, please complete and submit this application personally with: (1) PROOF OF PALAU CITIZENSHIP; (2) PROOF OF IDENTITY; (3) ONE COLOR PHOTOGRAPH; (4) FEE. Check visa requirements with consular offices to be visited.

1. PROOF OF CITIZENSHIP

(a) APPLICANTS BORN IN PALAU

Submit previous Palau passport or birth certificate. A birth certificate must include your given name and surname, date and place of birth, name of parent(s), date the birth record was filed, and seal or other certification of the official custodian of such record.

IF NO BIRTH RECORD EXISTS, submit baptismal certificate, or early census record along with notarized affidavits of persons having knowledge of your birth. Evidence should include your given name and surname, date and place of birth, and seal or other certification of office and signature of issuing official.

(b) APPLICANTS BORN OUTSIDE OF THE REPUBLIC OF PALAU

In addition to the documents required in (a) above, submit your previous Palau passport, if any, Certification of Naturalization;

Certificate of Citizenship, or evidence described below:

IF YOU CLAIM CITIZENSHIP THROUGH BIRTH ABROAD TO ONE OR MORE PARENTS OF RECOGNIZED PALAUAN ANCESTRY, submit proof of parent(s) citizenship, parent(s) birth certificates, and affidavit of Palauan parent(s) showing all periods and places of residence/physical presence in the Republic of Palau and abroad.

If your name is not the same as on your birth certificate, provide certified documents showing the reason. (e. g. Marriage Certificates, Court Decrees, etc.)

Altered documents are not acceptable.

2. PROOF OF IDENTITY

If you are not personally known by the staff of the Passport Office, you must establish your identity to their satisfaction. You may submit items such as the following containing your signature and physical description or photograph which is a good likeness of you (e. g. Previous passports; Identification card, Drivers License or Certificate of Naturalization). Altered documents are not acceptable.

IF YOU CANNOT PROVE YOUR IDENTITY as stated above, you must appear with an IDENTIFYING WITNESS, a Palauan citizen who has known you for at least two (2) years. Your witness must prove his or her identity and complete and sign an “Affidavit of Identifying Witness” before the Clerk of Court.

3. ONE PHOTOGRAPH

Submit one photograph of you, sufficiently recent (taken within the last six (6) months) to be a good likeness of you. It must bear a size of 2”x2”. Photographs must be a clear, front view, full face, taken in normal street attire without a hat or dark glasses, and printed on thin paper with a plain light (white) background. Photograph must be in color. Photographs retouched so that your appearance is changed are unacceptable. Snapshots, most vendor machine prints, and magazine or full-length photographs are unacceptable.

4. FEES

Passport Fee is $50.00.

Renewal Fee is $50.00.

Amendment/Validation is $25.00.

Replacement is $75.00.

Official and Diplomatic passports, no fee.

Pay the passport fee at the National Treasury, Republic of Palau or in one of the following methods:

Bank draft or cashier’s check; Money Order (United States Postal, International Currency Exchange); United States currency. Make fees payable to the National Treasury, Republic of Palau.

Failure to provide the information requested on this form may result in the denial of a Palau passport, related document, or service.

FORM PA-1

PASSPORT APPLICATION FORM – ROP/Rev. Jan.2005

PALAU PASSPORT OFFICE

Ministry of State, Republic of Palau

See Reverse for Instructions – EXECUTE IN ORIGINAL ONLY Type of Passport Requested ⁬Regular ⁬Official ⁬Diplomatic

Type or Print in Ink - APPLICATION MUST BE NOTORIZED

FULL NAME:

LAST

FOR OFFICIAL OR DIPLOMATIC APPLICANTS ONLY

FIRST

MIDDLE Official Title: _______________________________________

_______________________________________________________________________________ Duty Station: _______________________________________

Mailing Address: Post Office Box Number, Street, City, State, Zip Code

IDENTIFYING INFORMATION

_____________________________ ___________ Height __________feet__________inches _________________________ _________________________

Social Security No. Sex Color of Hair Color of Eyes

_____________________________________________ __________________________________________ ___________________________________________

Distinguishing Marks or Features Place of Birth Date of Birth

_______________________________________________________________ __________________________ _________________________ □Yes □No

Father’s Name Place of Birth Date of Birth Palauan Citizen

_______________________________________________________________ __________________________ _________________________ □Yes □No

Mother’s Name Place of Birth Date of Birth Palauan Citizen

MARRIAGE INFORMATION

Have you ever been married? ⁬Yes ⁬No DIVORCED/WIDOWED? ⁬Yes ⁬No

If yes, give date of most recent marriage _______________________________ If yes, give date of most recent divorce/death_____________________________

__________________________________________________________________ ___________________________________________________________________

Spouse’s Full Birth Name Former Spouse’s Full Birth Name

IN CASE OF EMERGENCY, NOTIFY (Person indicated will never travel with you)

__________________________________________________________________ _________________________________ ( )_______________________

Full Name Relationship Telephone Number

_______________________________________________________________________________________________________________________________________

Permanent and Mailing addresses

PREVIOUS PASSPORT INFORMATION

Have you ever been issued or included in a Republic of Palau Passport? ⁬Yes ⁬No Disposition: ⁬Submitted ⁬Lost ⁬Mutilated ⁬Stolen/Burned

Note: If passport is lost, mutilated, stolen or burned submit with affidavit , also for stolen or burned passports, police report required.

___________________________________ __________________ ___________________ ⁬ Cancelled & Returned ⁬ Attached

Name in which issued Passport Number Issuance Date

DO NOT SIGN APPLICATION UNTIL REQUESTED TO DO SO BY AN AUTHORIZED OATH-ADMINISTERING OFFICIAL

OATH AND SIGNATURE: I have not, since acquiring Palau citizenship, been naturalized as a citizen of a foreign state other than the United States; taken oath, or made affirmation or other formal declaration of allegiance to a foreign state (other than the United States); accepted or performed the duties of any office, post, or employment under the Government of a foreign state or political subdivision thereof (other than the United States); made a formal renunciation of nationality. I disclaim nationality in any state or country other than the Republic of Palau and the United States, that may have accrued to me through the nationality of my parents or for any other reason whatsoever and I hereby renounce absolutely and entirely all allegiance and fidelity to any foreign province, state or sovereignty other than the United States. I do not hold any passport or other form of travel document issued to me by any foreign state or sovereign, except for the United States.

DECLARATION: I declare that the statements made in this application are true and complete to the best of my knowledge and belief, that the attached photographs are a true likeness of me.