ETD Form raw text

ETD_Form_raw

Application for a United Kingdom Emergency Travel Document

Please supply the following:
> Passport sized photograph
> Police report (for stolen passports)
> Correct fee
> Form of personal identification
> Proof of travel

Please complete in black ink in block capitals
Applicant/Parent mustadd their initials at the bottom of every completed page



1 - Applicant details

Title 
Surname
First name and middle name(s)
Place of birth (city and country)
Date of birth
House name/number & street name
Town/City
Postcode
Country
Email address
Contact tel no.
Home tel no.

Is/has the Applicant been known by any other name? 
Yes []
No []
(if you answered Yes, please provide other names below)
Forenames
Surname

Forenames
Surname

Forenames
Surname



2 - Why are you making this application for an Emergency Travel Document?

The Passport is (tick one of the following) 
Lost  []
Stolen []
Expired []
Defaced/ Damaged []
Other []

If ‘Other’ please supply further information



3 - Details of the lost, stolen, expired or (other) passport

Was the Passport issued in the UK?
Yes []
No []

Country and City: (Complete if passport issued outside the UK)
Passport number (If known) 
Date of issue (If known)
Nationality (State Nationality shown on passport if known)

If you are not the applicant named above please provide your details below
Title
Surname
Forenames
Date of birth
Place of birth
Country of birth
Relationship to applicant (If you are applying for an ETD on behalf of the applicant, please indicate your relationship to them)



4 - Details of where and when lost/stolen passport last seen

Place of loss/theft (e.g. airport name, town)
Date of loss/theft
Country of loss/theft
Circumstances of loss/theft

Have local police been notified? 
Yes []
No []

Date reported to Police:
If Yes, please provide details
Police station
Police Report Number

Have you previously reported your/any passport lost or stolen?
Yes []
No []
If Yes, please provide details
Details



5 - Details of journey 

Departure date
Arrival date at destination
Countries transited
Mode(s) of transport (tick all that apply)
Plane []
Train []
Boat []
Car []
Coach []
Other  []

If ‘Other’ please supply further information

Country of final destination 
Purpose of travel
Departure date of return journey (if applicable)
Transit countries
Date of arrival



6 - Declaration

You are warned that the making of an untrue statement for the purpose of procuring a passport is a criminal offence

I am 16 years or over, I understand and declare that:

1. The person named in section 1 has not previously held a passport or other travel document of any description, or been included in one, other than that stated on this application, except for dual nationals who may hold a passport from their second nationality country. 
2. This application does not breach the terms of any court order in any jurisdiction.
3. No one included in this application owes money to Her Majesty’s Government for repatriation or similar relief.
4. The person named in section 1 has not been adopted outside the United Kingdom (or a qualifying territory), unless mentioned on this application.
5. The person named in section 1 is a British citizen, or British National (Overseas), or British Overseas Territories citizen, or British Overseas citizen, or British subject, or British protected person or an EU national or Commonwealth national and has not lost or renounced this status.
6. I, or the person named in section 1 of this application (if different), understand that by voluntarily applying for a British passport, the person named in section 1 may lose citizenship of another country.
7. If the person named in section 1 is under 16 years old, they do not hold a valid certificate of entitlement to the Right of Abode
8. The information on this application form is true to the best of my knowledge and belief and I understand that I shall be liable to prosecution and could face a prison sentence if I include anything that I know to be false or do not believe to be true.
9. I do not know of any reason why an Emergency Travel Document (ETD) should not be issued.
10. I understand that completing and returning this application form will result in any lost or stolen passport being cancelled, that it may never be used again and if subsequently found, it should be returned to the Foreign and Commonwealth Office (FCO), nearest Consular Post or Her Majesty’s Passport Office immediately.
11. I understand that the ETD is specific for the journey on the observation page, and that if this changes for any reason after the ETD is produced a new ETD will need to be requested and paid for.
12. I understand that the ETD fee is non refundable.
13. I understand that if making a single trip to the UK, the ETD will be retained by immigration staff on arrival as it will no longer be valid.  This may also happen in a number of other countries.
14. I also understand that the FCO and HMPassport Officehold and usedata for purposes notified to the Information Commissioner under the Data Protection Act 1998 (which may be consulted at www.informationcommissioner.gov.uk). Information about the lost or stolen passport may be shared with appropriate public and private sector authorities who can assist in locating and recovering the missing passport and to help prevent the passport being used for criminal purposes.
15. The guidance notes and the caution above have been read and understood.

Signature of applicant: (sign in box above using black ink if you are the person named in Section 1 and you are aged 12 or over. Otherwise, leave blank)
Date:
Place:

Signature of Parent/Guardian or person applying on behalf of applicant
Date: 
Place:



Further Information
7 - Applicant – Further Information

If you are a British National (Overseas) with a Hong Kong permanent identity card, please enter the number

Has the applicant been Naturalised or Registered? (Tick one box)
Yes []
No []



8 - Why are you making this application for an Emergency Travel Document – Further information

If you are applying by authority from the court please provide:
Court Name
Country Court



9 - Other Information

Please supply any other information that may affect your application for an Emergency Travel Document:

Signature:
Date:

Further Information for First-Time Applicants



10 - Details of any Full Validity Passport application

Has the applicant lodged a full validity passport application with HM Passport Office?
Yes []
No []

If Yes, please provide details
HM Passport Office reference number (if available)
Date application lodged

If No, please complete questions 11–14 below



11 - Applicant Information

Was the birth registered at a British Consulate? 
Yes []
No []
If so which one

Was the applicant registered as a British citizen, British Dependent/Overseas Territories citizen, British Overseas citizen, British subject or British protected person? 
Yes []
No []
If so what is the document number

Place of issue
Date of issue



12 - Parents Details 

Father’s full name
Town and country of birth
Date of birth
His citizenship at the time of the applicant’s birth, and if he was not a British citizen, his immigration status in the United Kingdom

If he has a British passport, please supply:
The passport number
Place and date of issue

If he became a citizen of the United Kingdom and colonies, British citizens, British Dependent/Overseas Territories citizen by naturalisation or registration, please provide:
His citizenship document number
Place and date of issue


Mother’s full name
Town and country of birth
Date of birth
Her citizenship at the time of the applicant’s birth, and if she was not a British citizen, her immigration status in the United Kingdom

If she has a British passport please supply: 
The passport number
Place and date of issue

If she became a citizen of the United Kingdom and colonies, British citizens, British Dependent/Overseas Territories citizen by naturalisation or registration, please provide:
Her citizenship document number
Place and date of issue



13 - Parent’s marriage (if applicable)

Date of marriage 
Place of marriage

To avoid delays with your application please ensure that you submit original versions of the documents listed here.  Additional documents may also be requested.

- Applicant’s original birth certificate including translation into English (if applicable) 
- Parent’s full UK birth certificates/ certificate(s) of naturalisation
- Parent’s marriage certificate
- If applicant is under 16 both parent’s passports and letters of consent to travel
- Applicant’s registration certificate(s) (if applicable)

Signature:
Date:



14 - Countersignature [for first-time applicants]

This section MUST be completed by the counter signatory who has personally known the applicant (or parent/guardian of applicant if under 16 years) for two years, and is not a relative of the applicant. 
Endorse the back of the photograph by writing ‘I certify that this is a true likeness of [insert name 
of child]’ and add your signature and the date on which the likeness was compared. 
Complete the following:

I [insert your full name] 
___________________________ certify that the applicant (or parent/guardian who has signed section 6) has been known personally to me for ___ years and that to the best of my knowledge and belief the facts stated on this form are correct.  I am a British national / citizen of ______________ [insert country].

House name/number & street name
Town/City
Postcode
Country   
Email address
Contact telephone number
Relationship to Applicant 
Nationality
Profession