SS5-PDF | BL SSC

PASSPORT APPLICATION

Step 1 of 7

Please select the type of Passport you are applying for*
- Passport Book
- Passport Card
- Both
Indicate if you want just the book (traditional passport), just a card (a card valid to enter Mexico and Canada only), or both.
What size of Passport Book do you want?*
- Regular 28 pages
- Large 52 pages
If you travel often, you can request a large passport (52 pages), otherwise you can request a regular size (28 pages). There is no extra cost for the large format.
About the Applicant
First Name*
Middle Name
Last Name*
Suffix
Enter any suffix your name may legally contain (ex: Jr, Sr ). DO NOT enter Mr, Ms, or Mrs
Social Security*
Enter your Social Security Number, if you have one. If you have not been issued a SSN, enter zeros.
Applicant Date of Birth*
Month
Day
Year
Enter your date of birth using (MM/DD/YYYY) format
City of Birth*
Country of Birth*
State / Territory of Birth*
Please choose the state/territory of your birth if you were born in the USA
Applicant Gender*
- Male
- Female
Height
Ft*
Enter the "feet" portion of your height
Inches*
Enter the "inches" portion of your height
Hair Color*
Choose the hair color that is closest to your hair color
Eye Color*
Choose the eye color that is closest to your eye color
Occupation*
Occupation is mandatory for adults and must be completed as descriptively as possible if a title alone will not make it clear. If you are not employed, state so in the occupation field. If you are self-employed, the type of work you perform should be completed in occupation and self-employed in employer. Children should enter STUDENT or CHILD in the occupation field.
Employer / School
Enter the name of the company where you work or the name of your school if you are a student. This field is optional and so you may choose not to enter any information.

Passport Application Services
Application Fee*
- $89.00
Optional Passport Insurance - $39.00*
- Yes
- No
300,000 people lose their passports each year according to the Deparment of State. If you are one of them, don't panic. With our Passport insurance, we'll provide you with the forms for your replacement free of charge if your document gets lost, stolen, or damaged.
TOTAL AMOUNT
$0.00
IMPORTANT: this is a one time application fee and does not include any applicable government filing fees
Click for an explanation of Government Fees and the processing times you can choose
You will select the processing time after submitting the application
Payment Info
Credit Card Type*
- American Express
- Discover
- Mastercard
- Visa
Credit Card*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address
- Same as Mailing Address
Enter Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Application Signature
Signature*
I hereby certify that the information provided on this application is true and accurate. I understand that the US Department of State supplies blank forms and instructions free of charge. Nevertheless, I wish to use Easy Apply's services with personalized instruction. I also certify that I agree with all Terms and Conditions herein described.
Name of Person Signing the Application*
This field is hidden when viewing the form
Last 4 Social Security*

Ber/Ley's PDF Tool is a private app that provides paid assistance in preparing and filing documents and is NOT affiliated with or endorsed by the SSA or any government agency. It is possible to obtain the SS-5 form for free at ssa.gov

We do not charge for the form itself but for the assistance in its preparation through our smart PDF tool. We do not review any forms from a legal standpoint. The use of this website is subject to its Terms and Conditions. Please consult our Privacy Policy to understand how we process information.

PASSPORT APPLICATION

Step 1 of 7

About the Applicant

Addresses

Travel Plans (Optional)

Emergency Contact (Optional)

Previous Passports

Your Most Recent Passport Book

Your Most Recent Passport Card

Lost or Stolen Passport Book Information

Lost or Stolen Passport Card Information

Other Passports Lost / Stolen

Parent and Spouse Information

List All Other Legal Names You Have Used

Passport Application Services

Payment Info

Application Signature