Fillable Form Statement Regarding Mutilated Passport

What is a Statement Regarding Mutilated Passport Form?

A Statement Regarding Mutilated Passport Form is a document used to declare the reason why a valid passport has been rendered unusable. It is required if a valid passport has been damaged, destroyed, lost, or stolen, and it cannot be submitted as proof of identity or citizenship to procure a new one.

If you are applying for a new passport and still have a valid or potentially valid passport in your record, the passport agency may ask for it so they can cancel or invalidate it. If you cannot present your passport, you must complete a Statement Regarding Mutilated Passport Form.

It is illegal for a United States citizen to hold more than one valid passport at a time. Thus, replacing a valid yet mutilated passport may be complicated as the passport agency may ask you for evidence of the damage. A Statement Regarding Mutilated Passport Form helps you provide the necessary information on a damage report.

How to fill out a Statement Regarding Mutilated Passport Form?

Before you fill out a Statement Regarding Mutilated Passport Form, make sure that your valid passport is indeed mutilated, lost, or stolen. Otherwise, once you report it to the United States Department of State, it will be invalidated. You cannot use an invalidated passport for any purpose.

IDENTIFYING INFORMATION

Enter your identifying information.

NAME

FIRST NAME

Enter your first or given name.

MIDDLE NAME

Enter your middle name.

LAST NAME

Enter your surname or last name.

SEX

Mark "Male" if you are a male or mark "Female" if you are a female.

PLACE OF BIRTH

Enter the city, state or province, and country where you were born.

ADDRESS (Street, City, State, ZIP Code)

Enter the street address, city, state, and ZIP code where you live.

PASSPORT NUMBER

Enter your passport number.

ISSUE DATE

Enter the date when your passport was issued.

PLACE OF ISSUE

Enter the place where your passport was issued.

DATE OF BIRTH

Enter the date when you were born.

MUTILATED PASSPORT INFORMATION

Enter information about your mutilated passport.

HOW WAS PASSPORT MUTILATED?

Provide an explanation of how your passport was mutilated.

WHEN WAS DAMAGE DISCOVERED?

Enter the date when you discovered that your passport was damaged or mutilated.

WHERE DID DAMAGE TAKE PLACE?

Enter the place where the damage to your passport took place.

IF STOLEN, WERE POLICE AUTHORITIES NOTIFIED?

Enter "Yes" if your passport was stolen and you notified the police authorities. Otherwise, you may enter "No" and provide an explanation.

IF YES, STATE WHERE AND WHEN

If your passport was stolen, enter when and where it was stolen.

WHAT EFFORTS HAVE YOU MADE TO RECOVER THE PASSPORT?

Provide an explanation about the efforts you have made to recover your passport.

HAVE YOU HAD PREVIOUS PASSPORTS LOST OR STOLEN?

Mark "Yes" if you had previous passports that were lost or stolen. Then, enter the date when it was stolen and particulars, such as the number of passports lost or stolen. If not, mark "No."

CERTIFICATION

By signing and dating your Statement Regarding Mutilated Passport Form, you certify that all information you provided is true and correct. You also certify that your passport was mutilated, lost, or stolen, and you did not give it to an unauthorized person.

Date

Enter the date when you signed your Statement Regarding Mutilated Passport Form.

Signature

Enter your signature.

What does a mutilated passport mean?

A passport is considered mutilated when it is unusable because of one or more tears, holes, or other damage that make the document illegible for travel. It cannot be accepted to prove your identity or citizenship.

Some of the reasons a passport can become mutilated include:

What are the documents required to replace a mutilated passport?

Passport replacement is possible when you do not have a valid passport in your possession, such as when your valid passport was lost or stolen. You may also apply for a replacement if your passport is damaged or mutilated.

Either of the given situations above, you may submit a Statement Regarding Mutilated Passport Form to the passport agency to provide a written and signed statement where you declare the reasons why your valid passport is rendered unusable.

Aside from a Statement Regarding Mutilated Passport Form, you need certain documents to apply for a passport replacement.

If your passport was lost or stolen, go to a passport agency and submit the following:

If your passport was mutilated or damaged, you may go to a passport agency and submit the following: