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Fillable Form DS-5504

Application Form DS-5504 should be submitted when applying to change your name in a valid passport, extend the validity of a limited passport or correct a printing error.

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What is DS-5504?

Form DS-5504is a special US passport application form used to apply for a US passport book and/or card if:

  • You have changed your name less than one year since your latest U.S. passport book and/or U.S. passport card issuance AND your U.S. passport book and/or U.S. passport card is less than one year old,
  • Your identifying information in your latest U.S. passport book and/or U.S. passport card was printed incorrectly, or
  • Your latest U.S. passport book was limited to two years or less for a reason other than multiple losses or a seriously damaged/mutilated passport.

How to Fill Out DS-5504?

Before filling out this form, ensure that all information you provide is complete and accurate. Any false information may result in delays in processing your application, denial of your application, fines, or imprisonment.

DS-5504 has 2 pages and requires a recent 2”x2” photo of yourself stapled on the first page.

Document(s) You Are Applying For

  • Check “US Passport Book” if you are intending to apply for a US passport book only.
  • Check “US Passport Card” if you are intending to apply for a US passport card only.
  • Check “Both” if you are intending to apply for both a US passport book and a US passport card.
  • Check “Regular Book (Standard)” if you are intending to apply for a regular US passport book.
  • Check “Large Book (Non-Standard)” if you are intending to apply for a large US passport book.

Line 1: Name
Provide your full legal name.

Line 2: Date of Birth
Provide the date of your birth in the following format: MM/DD/YYYY.

Line 3: Sex

  • Check “M” if you are male.
  • Check “F” if you are female.

Line 4: Place of Birth

  • If you were born in the US, provide the city and state where you were born.
  • If you were born outside of the US, provide the city and country were you born.

Line 5: Social Security Number
Provide your social security number.

Line 6: Email
Provide your email.

Line 7: Primary Contact Phone Number
Provide your phone number which you can primarily be reached.

Line 8: Mailing Address
Provide your mailing address.

Line 9: List of All Other Names You Have Used
Provide all other names you have ever used such as birth name, maiden name, previous marriage, legal name change. Provide additional pages if necessary.

Line 10: US Passport Book and/or Passport Card Information

  • Provide your name as printed on your latest US passport book and/or passport card.
  • Provide your latest US passport book number and its book issuance date (MM/DD/YYYY).
  • Provide your latest US passport card number and its card issuance date (MM/DD/YYYY).
  • Staple a recent 2”x2” photo of yourself beside this line on the box provided.
  • Provide your signature (parent or legal guardian’s signature if you are a minor).
  • Provide the date of when this form was accomplished.

Line 11: Height
Provide your height,

Line 12: Hair Color
Provide your hair color,

Line 13: Eye Color
Provide your eye color,

Line 14: Occupation
Provide your if you are 16 or older.

Line 15: Employer or School
Provide your employer or school if applicable.

Line 16: Additional Contact Phone Numbers
Provide additional contact numbers if any.

Line 17: Permanent Address
If your place of residence is different from your mailing address, provide your permanent address.

Line 18: Emergency Contact
Provide the name, address, phone number, and your relationship with the person who should be contacted in case of an emergency.

Line 19: Travel Plans
Provide the departure date, return date, and countries to be visited. For the dates, provide them in the following format: MM/DD/YYYY.

Additional Questions Regarding Your Current Passport Book and/or Passport Card

  • If your name has changed by marriage or court order less than one year after your U.S. passport book or passport card was issued and your submitted passport book and/or passport card is less than one year old, check “Yes,” provide your current name, and submit evidence documenting your name change. Otherwise, check “No.”
  • If your identifying information was printed incorrectly in your U.S. passport book or passport card, check “Yes,” provide your name, date of birth, sex, and place of birth, and submit evidence documenting your correct identifying information. Otherwise, check “No.”
  • If your latest US passport was limited for two years or less, check “Yes” and submit evidence of your US citizenship.

Submission

Submit and mail this accomplished form along with your latest US passport book and/or passport card and any documentary evidence requested to:

National Passport Processing Center
Post Office Box 90107
Philadelphia, PA 19190-0107

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