Lost or Stolen Passport Application

Complete this form to report your lost or stolen U.S. Passport and to apply for a new replacement.

Information About The Lost or Theft

Was your Passport lost or stolen?

Stolen

Lost

Was your lost or stolen passport a book or a card?

Book

Card

Full name as printed on passport

Passport book/card number (if known)

Passport issued date (if known)

Explain how the passport was lost or stolen

Explain where the loss or theft occurred. Provide Address if known (City/State)

Date when the lost or theft occurred? (Approx.)

Did you file a Police Report?

Yes

Have you had any other U.S. Passport lost or stolen?

Yes

U.S. Passport Holder Information

First Name

Middle Name

Last name

Suffix

Sex

Male

Female

Date of birth

Country of birth

State of Birth

City of Birth

Have the passport holder ever used another name?

Yes

Height

Feet

Inches

Characteristics

Hair Color

Eye Color

Contact information

Phone number

Additional Phone Number

Email address

Confirm email address

Mailing Address

Street

Apt, suite, floor, etc.

City

Country

State

Zip Code

Permanent address (PO BOX not allowed)

Is your permanent address different from your mailing address?

Yes

Job

Occupation

Marital status

Have you ever been married?

Yes

Passport Holder Mother Information

Add mother's information

Yes

Unknown

Mother first name

Mother middle name

Mother maiden name

Date of birth

Mother country of birth

Mother city of birth

Is your mother U.S. Citizen?

Yes

Passport Holder Father Information

Add father's information

Yes

Unknown

Father first Name

Father middle Name

Father last Name

Date of birth

Father country of birth

Father city of birth

Is your father U.S. Citizen?

Yes

Travel Plans

Do you have travel plans?

Yes

Emergency Contact

Do you want to add an emergency contact?

Yes

The terms should be accepted

By checking this box, I agree to submit the information provided to this website, and I authorize Express Travel Docs to use my information to fill all necessary documents in order to prepare my application materials. I understand that ustravelassist.com is a private document preparation service and that I am hiring them to prepare my passport application materials. I understand ustravelassist.com charges a service fee, and I will pay the passport agency a required fee directly by check or money order. I understand I may have to provide additional documents to the passport agency to prove my identity. I understand that I may receive newsletters from Express Travel Docs. By submitting the form above, I agree to these terms and this website's terms.