Fillable Form DS-3053

Form DS-3053 is a statement of consent to a non-applying parent or guardian for issuance of a U.S. passport for their child that is under the age of 16.

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What is Form DS-3053?


Form DS-3053, Statement of Consent: Issuance of a U.S. Passport to a Minor Under Age 16, is a form by the U.S. Department of State. It is used as a document that confirms consent when a minor’s parents or legal guardians are unavailable at the time the passport is executed.


 


Any information collected using Form DS-3053 is used in conjunction with Form DS-11, Application for a U.S. Passport. Take note that Form DS-3053 should be completed and notarized to be accepted as a statement of consent. Without a statement of consent, the minor applicant may not be eligible to apply and receive a U.S. passport.


 


Where to get Form DS-3053?


The official website of the U.S. Department of State provides a blank copy of Form DS-3053 that applicants can download, print, and fill out manually. Alternatively and for your convenience, those who are filing Form DS-3053 can electronically fill it out on PDFQuick.


 


How to fill out Form DS-3053?


Form DS-3053 is a single-page document that has five sections: Minor’s Name, Minor’s Date of Birth, Authorization Validity (This Authorization is Valid For), Statement of Consent, and Statement of Consent Notarization. Make sure to fill out all the sections accurately and truthfully to avoid any problems with your application.


 


Here are some specific  instructions from Form DS-3053 regarding how to fill it out:


  • Complete items 1, Minor’s Name; 2, Minor’s Date of Birth, and 3, Authorization Validity (This Authorization is Valid For). If Item 3 is not answered, the authorization will be valid for both a passport book and a passport card.

  • Complete Item 4, Statement of Consent, only if you are a non-applying parent or guardian consenting to the issuance of a U.S. passport for your minor child. It is important to note that your signature must be witnessed and notarized in Item 5, Statement of Consent Notarization.

  • The written consent from the non-applying parent that was sent together with an application for a new U.S. passport must not be more than 90 days old. Required with the written consent, presented to the notary, is a clear photocopy of the front and back of the non-applying parent’s government-issued photo identification.

  • Submit Form DS-3053 with the minor’s new Form DS-11 to any designated acceptance facility, U.S. Passport Agency, U.S. Embassy, or U.S. Consulate abroad.

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    If you are the parent or legal guardian of a minor applicant, follow the instructions below to fill out Form DS-3053 correctly.


     


    Item 1. Minor’s Name


    Enter the minor applicant’s full legal name in the following format: Last Name, First Name, and Middle Name.


     


    Item 2. Minor’s Date of Birth


    Enter the minor applicant’s date of birth in the following format: mm/dd/yyyy.


     


    Item 3. This Authorization is Valid For


    Mark the appropriate box to determine the validity of the authorization. You may select:


  • Passport Book and Card

  • Book Only

  • Card Only

    •  


    Item 4. Statement of Consent


    Print Name (non-applying parent/guardian)


    Enter your full legal name.


     


    Print Name (person applying for minor’s passport)


    Enter the minor applicant’s full legal name.


     


    Address


    Enter your complete address, including the Street Address, Apartment, City, State, and ZIP Code.


     


    Telephone Number


    Enter your telephone number, including the area code.


     


    E-mail Address


    Enter your active email address.


     


    Signature of Non-Applying Parent or Guardian


    Do not affix your signature yet. You must sign Form DS-3053 in front of a notary.


     


    Date


    Enter the date you signed the form in the following format: mm/dd/yyyy.


     


    Item 5. Statement of Consent Notarization


    Name of Notary


    The Notary Public should enter his or her full legal name.


     


    Location


    The Notary Public should enter his office’s location, including the City and State.


     


    Commission Expires


    The Notary Public should enter the date when his or her commission expires in the following format: mm/dd/yyyy.


     


    Identification Presented by Non-Applying Parent or Guardian


    The Notary Publis should mark the appropriate box to determine the identification document the non-applying parent or legal guardian has presented. He or she may select:


  • Driver’s License

  • Passport

  • Military ID

  • Other — Specify the identification presented.

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    ID Number


    The Notary Public should enter the identification number of the document presented.


     


    Place of Issue


    The Notary Public should enter the location where the presented identification document was issued.


     


    Issue Date


    The Notary Public should enter the issuance date of the identification document presented in the following format: mm/dd/yyyy.


     


    Expiration Date


    The Notary Public should enter the expiration date of the presented identification document in the following format: mm/dd/yyyy.


     


    Signature of Notary


    The Notary Public should affix his or her signature.


     


    Date of Notarization


    The Notary Public should enter the date he or she notarized Form DS-3053.


     


    Special instructions for institutions or entities granted guardianship:


    For institutions or entities that have been granted guardianship, the following documents should be submitted with Form DS-3053:


  • A certified order of a court of competent jurisdiction granting guardianship. Do not submit photocopies, as they are not acceptable.

  • A signed statement authorizing a specific person to apply for a U.S. passport for the child on its behalf. The statement must include the minor’s name and the name of the individual authorized to apply for the passport.

  • A photocopy of employee identification documents proving the person applying for the minor’s passport works at the institution or entity.

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    Tips related to filling out Form DS-3053:


  • Answer all the items accurately to avoid any problems or delays with the application.

  • Do not provide any false information deliberately as doing so is punishable by law.

  • You can electronically fill out Form DS-3053 and Form DS-11 online using a PDF online editor, such as PDFQuick for your convenience.

  • You may visit the official U.S. Department of State to learn more information about passport and travel information and to get answers to your questions about filling out Form DS-3053. The official website is travel.state.gov. You may also call the National Passport Information Center (NPIC) toll-free at 1-877-487-2778 (TDD 1-888-874-7793). Furthermore, you can email the NPIC at [email protected].

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    Fillable Form DS-3053