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*Please choose one of the available service options
*PVA's Main Contact
*Contact's relation to the child?
*Contact's Telephone Number
*Contact's Email Address
Party that referred you to PVA?
*Date of Departure from the USA?
*Date Birth Certificate in hand?
*Newborn's Date of Birth
*Newborn's City & State of Birth
*Newborn's First Name
Newborn's Middle Name
*Newborn's Last Name
*Newborn's Length?
Newborn's Social Security Number
*Twin's First Name
Twin's Middle Name
*Twin's Last Name
*Twin's Length?
Twin's Social Security Number
*US Mailing Address
US Apartment/Unit
*US City
*US State
*US Postal Code
US Domestic Phone Number (if applicable)
International Phone Number
*Email Address (this will go on the passport application)
*International (IP's Home) Mailing Address
International Apartment/Unit
*International City
International State/Province
*International Postal Code
*Country
*Emergency Contact in USA (can't be an international contact)
Emergency Contact Relationship to Baby
*Emergency US Mailing Address
Emergency Apartment/Unit
*Emergency City
*Emergency State
*Emergency Postal Code
*Emergency USA Telephone Number
*List Parents on the Birth Certificate
If the Gestational Carrier remains on the birth certificate and the passport is being applied for with two parents listed on the court order, list those two parents as the two parents on this application.
Parent First and Middle Name
Parent Last Name
*Parent Sex/Gender
*Parent US Citizen?
*Parent Date of Birth
Parent City/State or City/Province and Country of parent's birth
Parent 2 First and Middle Name
Parent 2 Last Name
*Parent 2 Sex/Gender
*Parent 2 US Citizen?
*Parent 2 Date of Birth
Parent 2 City/State or City/Province and Country of parent's birth
US City of Departure
Airline
List your Record Locator Number
Provide a four digit PIN #
List your preferred dates to be seen at a regional Passport Agency
Date 1
Date 2
List any dates you CAN'T appear at a regional Passport Agency
Date 1 - Can Not
Date 2 - Can Not
Check the TOP THREE Passport Agencies you would like for us to check for in-person appointments
Please confirm you are choosing the following service:
Securely upload your documents using the Upload buttons below
