British Overseas Territory - passport application

GET IT RIGHT

SECTION

Please check the accompanying guidance to this form carefully.

Fill in this form in CAPITAL LETTERS and black biro only. Please write only within the white boxes. Your application may be delayed if

you make a mistake, if you do not enclose the necessary documents or fee, or if you send photos that do not meet our guidance.

We will electronically scan and store the information you provide. Your passport

will have a digital image of your photo and signature.

We will

check the details you provide using information held by public and private sector organisations in order to determine whether

to issue a passport. Those details may be used by Her Majesty’s Passport Office to test our systems and to ensure the effective

operation of passport services. We may also contact you to ask if you are satisfied w

ith such services. We may pass information held

on your pass

port and on related passport records to public and private sector organisations in the UK and outside the UK when you

use your passport, obtain a service or when it is in the public interest to do so.

Further information can be found on our privacy statement at www.gov.uk/hm-passport-office.

E-mail address (You do not have to fill in your e-mail address in capital letters.)

Mobile phone number

Country of birth

Town of birth

Date of birth (DD/MM/YYYY)

Country

Current address (house number, street name, town/city)

Maiden or all previous names (surname first)

First and middle names

Surname

Cross (X) box Mr, Mrs, Miss, Ms, or write your title.

Alternative phone number

BOT

Male Female

Gender

Cross (X) the relevant box.

Postcode

Please include your full

address, including state

or province, and post

code where applicable.

You should include the

international code in

the phone number

boxes.

We will contact you once

your passport is ready

for collection

If there are any details

that you are not able to

fit in the boxes in

section 2, use the

boxes in section 8 to

provide the information

in full.

This form is for British

Overseas Territory

Citizen applicants only

USE BLACK BIRO

ONLY.

What type of passport are you applying for?

Who is the passport for?

Put a cross (X) in the relevant box.

Renewal of your passport (If you are an adult, see further

information on section 1 of the guidance notes.)

Your first British Overseas Territory Citizen Passport

Replacement for a passport that is lost, damaged or stolen

Extension of a passport to full validity

Changes to your existing passport (the renewal fee applies)

Do not use

Mr Mrs Miss Ms or title

Do not

use

New

photo

New

name

Adult

Adult Child (under 16)

(under 16)

(unde

r 16)

Child

BOT/01/01

British

Overseas Territory

passport application

GET IT RIGHT

If you are applying to

replace a lost or stolen

passport, you must also

fill in form LS01. Please

refer to the guidance

booklet for details on

where to obtain form

LS01. We cannot

process your application

until you send us form

LS01. If you have

already sent us form

LS01 please tell us at

Section 8.

BOT/01/02

BOEF

Partner Reference

Payment

Payment type

Block Application

SBC MC Photos

FBC PPT Nat Cert

Documents produced

PT PTOB/EX OB/EX OB/EX Other documents - specify

Office use only

SECTION

If they have a British Overseas Territories passport give the number

Date of birth (DD/MM/YYYY)

Town and country of birth

Nationality and citizenship at the time of the applicant’s birth

Have you had or been included on any sort of passport before?

Parents’ details

(You must fill in this section.)

A Has the person named in section 2 had any sort of passport

(British or otherwise) or been included in any passport before?

B You must send us all uncancelled passports with the application

(say how many in the box). If the passports are lost or stolen, go to 3C.

Father’s or Parent 2’s full name (surname first)

Mother’s or Parent 1’s full name (surname first)

Date of loss (DD/MM/YYYY)

How the passport was lost, or why it is not available

First and middle names

Holders surname at the time it was issued

Issued at

c Details of the lost and stolen passport

Place of loss

Date of marriage or civil partnership to the father or second parent of the person named in section 2 (if this applies).

If they have a British Overseas Territories passport give the number

Date of issue (DD/MM/YYYY)

If both parents named below were born after 31st December 1982 OR were born outside the territory in which you are applying, we will

also need the full name, town, country, date of birth and date of marriage of your grandparents (or details of your parents claim to British

Overseas Territory Citizen). Write these details in Section 8, or on a separate piece of paper.

Chq PO Csh

Cr/

Yes No

Go to 3B below.

3 Passport number2 Passport number1 Passport number

Lost/Stolen Passport number

in year

Post opener number

Fill in this section if you

are applying:

– for your first adult

British Overseas

Territory Citizen

passport

– to replace a British

Overseas Territory

Citizen passport that

has been lost, stolen or

damaged

– for a British Overseas

Territory Citizen

passport for a child

under 16, or

– to extend a British

Overseas Territory

Citizen passport.

If there are details you

are not able to fit in the

boxes in sectio n 4, use

the boxes at section 8

to include extra

information.

GET IT RIGHT

Please read the notes

on applications for

children. Section 9

must be signed by a

person with parental

responsibility for the

child.

GET IT RIGHT

This area is

intentionally blank,

please do not write in

this area

SECTION

Children aged 12-15

Has the person named in section 2 been granted a certificate of registration or naturalisation?

Cross (X) the box.

Certificate number Place of issue

Yes

Date DD/MM/YYYY

Give the date of issue here

and details below.

Children’s signature.

Applications will only be valid if you:

- Sign the white signature box below using black biro

- Keep within these marks

- Put date in date box to the right

Date DD/MM/YYYY

If the person named in section 2 is aged 12 to 15, they must sign and date this section

More information

If you need more space, please see the information on section 8 in the guidance notes at www.gov.uk

Notes

Type of passport

R SE SN DO DE NOPC

Certificate of registration or naturalisation

BOT/01/03

Office use only

Ofce use only

SECTION

GET IT RIGHT

If a parent or guardian

is signing section 9,

they must have

parental responsibility

and should give their

relationship to the

child. If the parents

are not married, the

father will not

normally have

parental responsibility.

Please see the

guidance notes for

more details.

The person acting as

the countersignatory

must sign section 10.

GET IT RIGHT

Please use the boxes at

Section 8 to tell us which

country’s passport your

countersignatory holds,

and his or her email

address.

To avoid unnecessary

delays, please do not

use a label or stamp

on this form.

Please enclose two

photos taken in the last

month that meet the

photo guidance.

On the back of only

one photo, the

countersignatory

must write “I certify

that this is

a true

likeness of...”giving

the full name and title

of the person named

in section 2. The

countersignatory

must sign and date

this endorsement.

By countersigning this application you agree

to us checking passport records to confirm

your countersignature

Designed in the UK by Adare Limited 774485-007 08/13

Countersignatures will only be

valid if you:

- Sign the white signature box

using black biro

- Keep within these marks

- Put date in date box to the left

a passport.

Name, if signing on behalf of a child (title, first name and surname)

Relationship to child

Date DD/MM/YYYY

Surname

Postcode

Current passport number

Mobile phone number

Alternative phone number

Date DD/MM/YYYY

I confirm that I have known the person named in section 2, or in the case of a child, the adult filling in section 9 (insert their name)

As far as I know, the information on this form is correct. I hold either a full current British, Irish, other EU, US, British

Overseas Territory or Commonwealth passport (delete as appropriate). I have read the caution and I understand it.

Profession, professional qualifications or position in the community

Your employer’s name and the address you work at (or your private address if this does not apply)

for (insert years) as (please say how - for example, employer, colleague, friend and so on).

yrs

Mrs Miss Ms or title

First and middle names

It is a criminal offence to make a false statement to get a passport. If you have made a false statement on this form, you

could be prosecuted and could go to prison. Our work includes checking that the countersignature in section 10 is genuine.

I declare that I am 16 years or over (or will be within two weeks) and that:

1 I will return a lost passport to a

British Overseas Territories Passport Office

if it comes into my possession;

2 I, or the person named in section 2 of this application (if different), am a British national and have not lost or given up my national status;

3 I have stated if the person named in section 2 was born of a surrogacy arrangement;

4 I do not owe any money to the

British Overseas Territories Government

for repatriation or similar relief;

5 this application does not break the terms of any court order

to which

I, and the person named in section 2 (if different)

am subject;

6 as far as I know all the information I have given in this

application

if the application is for a child, I have parental responsibility

and I have enclosed any court orders that relate to the child’s

residence, contact or removal from the

British Overseas Territory

understand that by voluntarily applying for a British

Overseas

Territories Citizen

passport, I may lose my citizenship

of another

country; and

9 I have read both the guidance notes and the caution above

and

fully understand the consequences of my actions in

applying for

Before signing, please read the guidance booklet

Applications are only valid if you:

- Sign the white signature b

ox below using black biro

- Keep within these marks

Declaration This must be filled in by the person named in section 2. If under 16, their parent or guardian must fill this in instead.

Countersignatory If a countersignature is needed, they must fill in this section after the rest of the form has been filled in.

Caution It is a criminal offence to make a false statement to help someone get a passport. Check the form properly before

you fill in this section. If you have made any false statements on this form, or if you know that the person applying

has made any false statements on this form, you could be prosecuted and could go to prison.

Our work includes checking that your details are genuine. As a result, we may need to contact you. You should not

sign this form if you are a relative of t

he person applying.

IMPORTANT If the application is for a child, you are confirming the identity of the adult signing in section 9. You must

also be able to identify the child in order to certify the photograph.

Fill in the following in CAPITAL LETTERS and black biro. (cross (X) box Mr, Mrs, Miss, Ms, or write your title)

BOT/01/04

Signature

country of residence;

8 I, or the person named in section 2 of this application (if different),

is correct;