REPUBLIC OF L IBERIA
BUREAU OF PASSPORT & VISAS
MINISTRY OF FOREIGN AFFAIRS
MONROVIA, LIBERIA
LIBERIAN ECOWAS BIOMETRIC PASSPORT APPLICATION FORM No._______
PLEASE PRINT IN BLOCK/CAPITAL LETTERS
1. NAME: __________________________________________________________________________________________________
Last Name First Name Middle Name
2. PREVIOUS NAME: ________________________________________________________________________________________
3. SEX/GENDER: Female Male 4. DATE OF BIRTH: _______________________________________________
Month Day Year
5. HEIGHT: _____________(ft.in)
6. PLACE OF BIRTH: ____________________________________________________________________________________________________
___________________________________________________________________
Town/City County Country
7. PROFESSION/OCCUPATION: __________________________________________________________________________________________
___________________________________________________________________
8. NATIONALITY: __________________________________________________
A. Citizen: If Liberian, provide Birth Certificate/Liberian Passport/Road to Health Chart/National ID Card.
B. Naturalization: If naturalized, provide documents.
C. Declaration: If by declaration, provide (Court Decree of Oath of Allegiance)
D. Have you obtained naturalization in a foreign state? Yes No
E. Have you ever taken an Oath or made an affirmation or formal declaration of allegiance to a foreign state? Yes No
F. Have you ever been issued a Liberian Passport? Yes No . If yes state issuance date______ and passport No._______
G. Have you ever served in the armed forces of another state? Yes No
H. Have you ever voted in the political election of another state? Yes No
I. Have you ever made a formal renunciation of Liberian Nationality before a diplomatic or counselor officer
of Liberia in a foreign state? Yes No
If yes, please state the country._________________________________________________________________________________________
8 a. ADDRESSS: __________________________________________________________________________________________
___________________________________________________________________
9. MARITAL STATUS: Single Married Separated Divorced Widow (er)
10. CONTACT NUMBER: _____________________________________
11. Email Address: ________________________________________
12. ARE YOU EMPLOYED? Yes No
13. EMPLOYER: _____________________________________
Employer:__________________________________________
14. HAVE YOU EVER BEEN ISSUED A LIBERIAN ECOWAS BIOMETRIC PASSPORT? Yes No Passport#:_________________
15. CITY OF APPLICATION: Monrovia, Liberia 16. APPLICATION DATE: __________________________________
Month Day Year
17. FATHER’S NAME: _________________________________________________________________________________Living Dead
Name County/Country of Origin
18. MOTHER’S NAME: ________________________________________________________________________________ Living Dead
Name County/Country of Origin
19. TWO PERSONS TO VOUCH FOR YOUR CITIZENSHIP:
A. ___________________________________________________________________________________________________________
_________ Name Relationship Contact
B. ___________________________________________________________________________________________________________
_________ Name Relationship Contact
20. TWO PERSONS TO CONTACT IN CASE OF EMERGENCY:
A. ___________________________________________________________________________________________________________
_________ Name Relationship Contact
B. ___________________________________________________________________________________________________________
Name Relationship Contact
●ALL FEES COLLECTED DURING THE PROCESSING OF LIBERIAN ECOWAS BIOMETRIC PASSPORT IS NON-REFUNDABLE.
DISCLAIMER
21.
I hereby declare that the information provided herein are true and correct to the best of my knowledge. NOTE: you could be
prosecuted for perjury or attempt to falsify Liberian Citizenship if your information is not true and correct.
Signed _____________________________________________ Date: ___________________________________________________________
Applicant’s Signature/Thumb Print Day Month Year
