P.F.

136A

APPLICATION FOR RENEWAL OF MAURITIUS PASSPORT

(Regulation 4(5A) of the Passports Regulations 1969)

Complete all sections relevant to you in BLOCK LETTERS by using BLACK ink. You must be a Citizen of Mauritius to qualify for a Mauritius passport.

(Please fill in name in which passport to be issued)

Application no
(for official use)

C I

Passport no.
(for official use)

(1) Eligibility for Renewal of passport

(a) Particulars of passport to be renewed
- SEP - 2005
(i) Passport Number: 0982005
.. Date of issue: 03
....

(ii) Reason for renewal of passport: Expired

Filled with stamps

(b) Has there been a change in your name, citizenship or marital status since you made your last application for a passport?
Yes

No

If yes, please produce required documents.

(2) Particulars of Applicant

a)

SURNAME

b) FORENAMES
c)

N
S

MAIDEN
NAME
8

d) NIC NUMBER
e)
f)

TITLE
(Mr/Mrs/Miss)

SEX Male

Female

DATE OF
BIRTH

(date format DD MM YYYY e.g 30 12 1999 )

PORT LOUIS, MAURITIUS

ENGINEER
Place and country of birth: ............................................................
Occupation/Profession....

89, CNR REMY OLLIER AND ETIENNE PELLEREAU STREETS, PORT LOUIS
g) Local address: .

h) Address abroad: -...

i) Home Tel No: 2407043
...

Office Tel No (if any): 2065200

..........

Email address (if any): m.s.wagirkhan@gmail.com

.

(3) Notes
a) Photo specifications: Person in whose name passport is to be issued to submit two identical copies of photograph of less than
six months. The size of these photographs must be between 35mm and 40mm in width and between 45mm and 50mm in height
and taken against a light background. The face length from Chin to Crown of head shall be between 25mm and 35mm (0.98
in and 1.38 in). The photographs should be matt and taken full face, without hat and with eyes wide open. They should be clear
and taken in a neutral expression with mouth closed. If applicant/minor wears glasses, the eyes should be visible.
b) Passport will, as far as possible, be issued within four working days after payment.

(4) Documents to be produced

a) Adults
b) Minor

Previous passport + photocopy of the bio data page

National Identity Card, (original + photocopy) + Two recent identical photographs (passport size)
Previous passport (original + photocopy of data page)
National Identity Cards of parents/guardians or copy of Judges Order (where applicable), (original + photocopy)
Two recent identical photographs (passport size)

(5) Signature or thumbprint of *applicant/minor

Specimen signature or thumbprint of *applicant/minor
to be shown on the passport. (Failure to comply with
instruction to Keep within inner border lines of the
box below will invalidate this application).

R. Robinson
(specimen signature)

(Use felt pen 0.6mm with black ink only)

Minors only
(6 A) Consent of parents or guardian for application by minors (under 18 years).
I/We, the undersigned, hereby, authorize the issue of a passport to the abovenamed minor. I/We declare that the
information given in the application is correct and that the abovenamed minor has not lost his status of Citizen of Mauritius.
Father/Guardian

Mother/Guardian

....
Name
Name
.. .. ....
Signature/Right Thumbprint
Signature/Right Thumbprint
. ...
NIC or Passport No.
NIC or Passport No.
(6 B) Certification of Consent
I certify that the father and mother or legal guardian affixed his/their signatures/right thumbprint/s under paragraph (6A) above
in my presence.
Rank, Dept. No. and Name of Police Officer: ......
.
(in block letters)
...
Signature & date

Office Stamp

Place where consent given: ....

(7) Declaration of applicant/minors parents or guardian

(A) I declare that I am a citizen of Mauritius and have not renounced my citizenship or lost it through acquisition of
another nationality, and the documents and statements produced are true and correct. I am also aware that in
case I have supplied any false information/ document, I am liable to prosecution and any passport issued will be
cancelled.
OR
(B) I declare that my ward is a citizen of Mauritius and has not lost his/her citizenship of Mauritius through
acquisition of another nationality, and the documents and statements produced are true and correct. I am
also aware that in case I have supplied any false information/document, I am liable to prosecution and any
passport issued will be cancelled.
Signature/thumbprint of applicant: .. Date: ..
Or of parents/guardian of minor
Print
( DD/MM/YYYY e.g 30/12/1999 )

FOR OFFICIAL USE ONLY

NAME

INITIAL

Approval

NO OBJECTION CERTIFICATE

Checked name not on record

Processed by
Signature: .

Payment slip ordered by

D/Captured by
Scanned by
Printed by

Date

Date:..
Checked by:...