INSTRUCTIONS FOR FSM PASSPORT APPLICATION
Revised July 2007
Only FSM citizens may apply for an FSM passport. FSM passports are issued ONLY by theFSM Department of Justice; Division of Immigration & Labor as listed below:
Chief, Division of Immigration
FSM Department of Justice
P.O. Box PS-157
Palikir, Pohnpei FM 96941
PLEASE PROVIDE THE FOLLOWING REQUIRED DOCUMENTS
WHEN APPLYING:
FOR NEW PASSPORT:
1.) Court Registered Birth Certificate;2.) If record of Birth Certificate is unavailable, a Court registered Baptismal Certificate isacceptable;
3.) 2 identical passport photos (standard passport photo size);4.) If applicable, provide a Court Registered Marriage Certificate for maiden name change;
and5.) For Naturalized FSM Citizen, provide copy of Naturalization Certificate;6.) Payment for new passport fee of $50.00 to be in Money Order or Cashier’s Checkpayable to FSM National Treasury.

FOR PASSPORT RENEWAL:
1.) Submit your EXPIRED PASSPORT with your Application Form(Note: Please remove
your I-94 from expired passport BEFORE mailing. Attach I-94 to new passport);
2.) 2 identical passport photos (standard passport photo size);
3.) Payment for passport renewal fee of $50.00 to be in Money Order or Cashier’s Checkpayable to FSM National Treasury.
FOR PASSPORT REPLACEMENT (for LOST, STOLEN, DAMAGED, or MUTILATEDPassports):
1.) Submit Application Form;
2.) 2 identical passport photos ( standard passport photo size);3.) Sworn Affidavit;
4.) Payment for passport replacement fee of $75.00 to be in Money Order or Cashier’s
Check payable to FSM National Treasury.
Note: A passport without blank visa pages may be replaced before Expiration Date. Submit
Application Form, Passport, 2 identical passport photos, a payment for passport replacement
fee of $50.00 in Money Order or Cashier’s Check payable to FSM National Treasury.
POSTAGE FEES: FSM Citizens applying for a passport from the USA must include a moneyorder (no cash or personal checks), payable to FSM Postmaster General, to cover cost of postage
for mailing the PASSPORT from FSM to your mailing address in US. The FSM Government isno longer able to cover this expense. Please include a total of $13.00 to cover cost of postage.
The $13.00 will cover $4.05 for priority mailing (up to 1 lb.) and registered mail services (1booklet $8.50 or 2 booklets $8.77). You must be sure that your correct mailing address is on yourapplication. As postage rates may change from time to time, it is a good idea to first check withthe local postal service agency in your residential prior to mailing.
PHOTOS: Photos should be color. Do not sign the front of the photographs. When having
picture taken: do not use sunglasses, sleeveless shirts, large combs or other articles that stick outfrom head. Do not use leis, hats, earrings, or other items distracting to the photograph. Official
and Diplomatic passport applicants must wear appropriate attire.

BEFORE MAILING YOUR APPLICATION, MAKE SURE the application is complete,signed and notarized; 2 identical color passport photos(standard passport size); Payment(Money
Order or Cashier’s Check); Birth Certificate (if NEW applicant); Sworn Affidavit (if passport islost, stolen or damaged); and postage fees are enclosed.
FSM PASSPORT AND I-94 ARE IMPORTANT DOCUMENTS
The FSM Embassy in Washington recommends that you keep your passport current at alltimes. In the case that you are renewing your passport, please remove your I-94 from yourexpired passport and keep it in a safe place. You may attach your I-94 in your new passport
when you receive it.

For more information, please contact:
FSM Immigration Headquarters
Telephone: 011-691-320-5844/2605
Fax: 011-691-320-7250
Email: imhq@mail.fm

FSM Embassy, Washington, DC (202)223-4383 or visit the Embassy’s website
at http://www.fsmembassydc.org###

FSM FORM 5001B-REVISED FORM 5001A

FSM PASSPORT APPLICATION FORM

Applicant Photo

FOR OFFICIAL USE ONLY

Applicant must complete this form and forward it to theDivision of Immigration & Labor, Department of Justice,
FSM National Government, Palikir, Pohnpei FM 96941

Document Issued On: ______________
Issuing Official:___________________

1 3/16 x 1 ¾

PLEASE FOLLOW INSTRUCTIONSType of Passport: [ ] Ordinary [ ] Official [ ] Diplomatic
Applicant Information
Name: __________________________________
Last Name______________________
Middle Initial______________________________________First Name

Other Names You Have Used:__________________________________________________________________________________
Date of Birth: ____________________ Gender
Height: ________________ Feet

[ ] Miss_____________Inches[ ] Mrs.

[ ] Ms.

[ ] Mr.

Hair Color___________ Eye Color ___________

Birth Place: ______________________________ Home Address:_______________________________________________________
Current Postal Address:_________________________________________________________________________________________Have you ever been issued a foreign passport: [ ] Yes [ ] No
If yes, country of issuance, date issued and passport number____________________________________________________________
Basis of FSM citizen: [ ] Birth [ ] Naturalization [ ] Other means (Provide prove)
Father Information
Last Name:_________________________ First Name:_____________________________ Middle Name: ______________________
Birthdate:_________________________ Birthplace:_________________________ Is your father FSM citizen? [ ] Yes [ ] No
If no what nationality:________________________
Mother Information
Last Name:__________________________ First Name:_____________________________ Middle Name:______________________
Birthdate:_________________________ Birthplace:________________________ Is your mother FSM citizen? [ ] Yes [ ] No
If no what nationality:_____________________

Signature of Applicant Required (Do not sign in the box for infant and adult who cannotSign)
Please sign within the box. Signature must not touch line.

Signature of parent or guardian if under age 14 or unable to sign application._____________________________________________________________________

Subscribed and sworn to before me this ____________day of ______________ 20

S E A LI hereby certify that I reviewed the application and found to be complete and I am satisfied that the applicant is a citizen of the Federated States of Micronesia, andthat he/she does not owe allegiance to any foreign country.
____________________________________
Reviewing Officer_________________________Date

AFFIDAVITFOR LOST/DAMAGED OR STOLEN FSM PASSPORT
Application for Renewal or Replacment of FSM Passport

I, _____________________________, citizen of the Federated States of Micronesia(Full legal name as shown on passport)(FSM), born in __________________ State in the FSM on ____________________,(Place of Birth)(Date of Birth)

hereby verify and confirm that I am applying for a renewal or replacement FSM passportbecause my previous FSM passport was:()damaged and hereby attached to this application()

stolen()lost

I swear that this statement is true and hereby submit my application for a new FSM
passport.
Signature________________________________
Date* This affidavit must be notarized.

________________________________