Form DS-64 PDF Details

Navigating through the process of dealing with a lost or stolen U.S. passport can feel daunting, but the DS-64 form is a crucial step in safeguarding one’s identity and facilitating the issuance of a replacement passport. This form serves as an official statement to the U.S. Department of State, outlining the circumstances under which a passport was lost or stolen. Applicants have multiple options for reporting their situation: submitting the DS-64 form alongside a new DS-11 application at a designated acceptance facility or U.S. passport agency for those seeking a replacement, reporting the loss or theft online, via phone, or by mail if not applying for a new passport immediately. It's not just a formality; this process helps prevent identity theft and ensures that no one can misuse the missing passport. Importantly, the information provided is integrated into the Consular Lost and Stolen Passport System, rendering the passport invalid for travel and assisting in the protection of the passport holder’s identity. Moreover, adhering to the guidelines, including providing a Social Security number, is pivotal for verification purposes and to avert delays. Offering this information might feel like a small step, but it plays a significant role in national and individual security. Compliance with these procedures also underscores the seriousness of the situation, as making false statements can result in penalties, including fines and imprisonment, underscoring the dual objectives of these protocols: securing one’s identity while ensuring the integrity of U.S. travel documents.

QuestionAnswer
Form Name Form DS-64
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names ds64, lost passport, ds passport forms, passport lost information get, statement regarding a valid lost or stolen passport

Form Preview Example

U.S. Department of State

STATEMENT REGARDING A LOST OR STOLEN U.S. PASSPORT BOOK AND/OR CARD

HOW TO REPORT A LOST OR STOLEN PASSPORT BOOK AND/OR CARD

To report a lost or stolen passport, please choose ONE of the following options:

1.To apply for a new U.S. passport book and/or card please submit this form with a new DS-11, Application for a U.S. Passport, to any designated acceptance facility, U.S. passport agency, U.S. embassy, or U.S. consulate abroad.

OR

2. Report a lost or stolen U.S. passport online by visiting our website at travel.state.gov.

OR

3. Report a lost or stolen U.S. passport by phone by calling 1-877-487-2778 (TDD: 1-888-874-7793) and following the representative's instructions.

OR

4.Submit this form by mail AND a photocopy of a government-issued photo identification (such as a driver's license or state-issued identification) to the following address* ONLY IF you are NOT applying for a new U.S. passport book and/or card:

ATTN: CLASP

U.S. Department of State

CA/PPT/S/L/LE

44132 Mercure Cir

P.O. Box 1227

Sterling, VA 20166-1227

* Only use this address to submit this form or other correspondence about lost/stolen passports. For general inquiries, call the National Passport Information Center at 1-877-487-2778.

Protect yourself against identity theft! Report a lost or stolen U.S. passport!

For more information, please visit our website: travel.state.gov

WARNING

False statements made knowingly and willfully on this form, in U.S. passport applications, or in affidavits or other supporting documents submitted therewith are punishable by fine and/or imprisonment under U.S. law, including the provisions of 18 U.S.C. 1001 and/or 18 U.S.C. 1542. Alteration or mutilation of a U.S. passport is punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1543. The use of a U.S. passport in violation of the restrictions contained therein or of the passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents submitted are subject to verification.

PRIVACY ACT STATEMENT

AUTHORITIES: We are authorized to collect this information by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 8 U.S.C. 1737; Executive Order 11295 (August 5, 1966); and 22 C.F.R. Parts 50 and 51.

PURPOSE: We are requesting the information to ensure that no one has more than one valid U.S. passport book and one valid U.S. passport card at any one time, except as authorized by the U.S. Department of State, and to combat passport fraud and misuse.

The collection of the Social Security number will be used to verify the identity of the person reporting the lost or stolen passport and to identify the passport being reported lost or stolen. There is no other purpose unless authorized by law.

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 information can be found in System of Records Notices State-05, Overseas Citizen Services Records and Other Overseas Records and State-26, Passport Records.

DISCLOSURE: Providing your Social Security number and other information on this form is voluntary, but failure to provide the information on this form may, given the form's purpose of verification of your identity, result in processing delays.

PAPERWORK REDUCTION ACT STATEMENT

Public reporting burden for this collection of information is estimated to average five minutes per response, including 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, Attn: Passport Forms Officer, 44132 Mercure Cir., P.O. Box 1227, Sterling, VA 20166-1227.

DS-64 07-2018

Page 1 of 2

U.S. Department of State

OMB CONTROL NO. 1405-0014

OMB EXPIRATION DATE: 11-30-2021

 

Please Print Legibly Using Black Ink Only

ESTIMATED BURDEN: 5 Minutes

STATEMENT REGARDING A LOST OR STOLEN U.S. PASSPORT BOOK AND/OR CARD

IMPORTANT NOTICE

A U.S. national may not normally bear more than one valid or potentially valid U.S. passport book and/or card at a time. Therefore, a statement is required when applying for a new U.S. passport if the previously valid or potentially valid passport is not submitted. Your statement must detail why the previous U.S. passport cannot be presented. The information you provide on this form will be placed into the Consular Lost and Stolen Passport System, which is designed to prevent the misuse of all reported lost or stolen passports. If more than one U.S. passport previously issued to you was lost or stolen, your replacement passport may be limited in validity. Once reported, the lost or stolen passport is electronically cancelled and MUST NOT BE USED FOR TRAVEL. Anyone (including the bearer) traveling on a reported lost or stolen passport may be detained upon entering the United States. Should you locate the passport after reporting it lost or stolen, submit it for cancellation to the Consular Lost and Stolen Passport Unit (CLASP). See page one of this form for contact information.

Please select the document (or documents) that you are reporting and its status.

Lost

U.S. Passport Book U.S. Passport Card

Stolen

Lost

Stolen

1. IDENTIFYING INFORMATION OF PASSPORT HOLDER: Type or print legibly in black ink in white areas only.

Last Name

 

 

First Name

Middle Name

 

 

 

 

 

 

 

 

Has your name changed since the passport was issued? If yes, state the name in which the lost or stolen passport was issued.

 

 

 

 

 

 

 

 

 

Sex

 

 

 

 

Date of Birth (mm-dd-yyyy)

Place of Birth (City & State if in U.S. or City & Country)

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

Female

Male

 

 

 

 

 

 

 

 

 

 

 

 

Current Address (Street, City, State, and ZIP Code or Country, if outside the U.S.)

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

Alternative Telephone Number

E-mail Address

(

)

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

2.LOST OR STOLEN U.S. PASSPORT BOOK/CARD INFORMATION: Answer all questions completely. If you do not know the answer in detail, be as exact as possible.

Are you submitting this form in connection with an application for a new U.S. passport book and/or card?

 

Yes

 

No

 

 

Explain how your U.S. passport book/card was lost or stolen.

Explain where the loss or theft occurred. Provide the address, if known (City and State, if in the U.S., or City and Country as it is presently known)

On what date was your U.S. passport book/card lost or stolen (mm-dd-yyyy)? If unknown, when was the last time you remember it being in your possession?

List your lost or stolen U.S. Passport Book, if known:

 

 

List your lost or stolen U.S. Passport Card, if known:

 

 

 

Issue

 

 

 

Issue

 

 

Number

Date (mm/dd/yyyy)

 

 

Number

Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

Have you had any other U.S. passport book/card lost or stolen?

Yes

No

 

 

 

If yes, how many passports?

 

Approximate date(s)?

 

Did you file a police report?

Yes

No

 

 

 

 

 

 

(If yes and the report is available, please submit a copy.)

 

 

 

 

 

 

3. YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW

I, the undersigned, declare under penalty of perjury all of the following: 1) that I have read and understood the warning on page one of this form; 2) the information provided herein is correct and complete; 3) I have not given my U.S. passport book and/or passport card to another person or disposed of it in an unauthorized manner; 4) I understand that the U.S. passport(s) I report as missing will be invalidated and cannot be used; and 5) if I subsequently find and recover it, I will immediately return the passport and/or passport card to Passport Services at the address on page one of this form or to the nearest U.S. passport agency, U.S. embassy or U.S. consulate, if abroad, and I will not attempt to use it.

Legal Signature - age 16 or older or Parent/Guardian if under age 16

Legal Signature - Parent/Guardian if under age 16

Date (mm/dd/yyyy)

Date (mm/dd/yyyy)

Both parents or guardians of a child younger than 16 years old must sign and provide photocopy of ID when submitting this form on the child's behalf unless one parent or guardian has sole custody. If there is sole custody, include a copy of a supporting document, such as a court order, with this form.

DS-64 07-2018

Page 2 of 2

How to Edit Form DS-64 Online for Free

Through the online PDF editor by FormsPal, it is possible to fill in or edit passport statement form here. We at FormsPal are committed to giving you the absolute best experience with our editor by constantly introducing new features and enhancements. Our editor has become even more user-friendly as the result of the latest updates! Currently, editing documents is easier and faster than before. Should you be looking to get started, this is what it's going to take:

Step 1: Click the "Get Form" button at the top of this webpage to access our PDF tool.

Step 2: The tool provides you with the capability to change PDF files in a variety of ways. Change it by including personalized text, correct what's already in the PDF, and put in a signature - all close at hand!

With regards to the blanks of this particular form, here is what you need to do:

1. You have to fill out the passport statement form accurately, so be attentive when filling out the segments containing all these fields:

Step no. 1 in filling out passport statement form

2. Once the last section is completed, you're ready to include the needed details in Did you file a police report If, List your valid lost or stolen US, Issue Date mmddyyyy, List your valid lost or stolen US, Have you had any other valid US, Yes, No If yes how many passports, Issue Date mmddyyyy Approximate, mmddyyyy, Did you file a police report If, Yes, Applicants Legal Signature age, MotherFatherParentGuardian Legal, MotherFatherParentGuardian Legal, and Date mmddyyyy in order to move forward further.

Filling in part 2 of passport statement form

Be extremely attentive while filling out List your valid lost or stolen US and List your valid lost or stolen US, as this is the part in which many people make mistakes.

Step 3: Ensure that the details are correct and then click on "Done" to proceed further. Right after getting a7-day free trial account here, you'll be able to download passport statement form or send it through email promptly. The PDF document will also be readily available from your personal account menu with your every edit. With FormsPal, you can easily complete documents without having to get worried about personal information breaches or records getting shared. Our protected software makes sure that your personal details are kept safely.

Form DS-64 isn’t the one you’re looking for?

Related Documents